Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.A.B., Z.H., C.F., A.C.R., J.H., T.N.K.).
Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine (J.N.).
Hypertension. 2021 Jul;78(1):4-15. doi: 10.1161/HYPERTENSIONAHA.121.16509. Epub 2021 May 17.
More than half of US adults have hypertension by 40 years of age and a subsequent increase in atherosclerotic cardiovascular disease risk. Dietary sodium and potassium are intricately linked to the pathophysiology of hypertension. However, blood pressure responses to dietary sodium and potassium, phenomena known as salt and potassium sensitivity of blood pressure, respectively, are heterogenous and normally distributed in the general population. Like blood pressure, salt and potassium sensitivity are complex phenotypes, and previous research has shown that up to 75% of individuals experience a blood pressure change in response to such dietary minerals. Previous research has also implicated both high salt sensitivity and low salt sensitivity (or salt resistance) of blood pressure to an increased risk of hypertension and potentially atherosclerotic cardiovascular disease risk. Given the clinical challenges required to accurately measure the sodium and potassium response phenotypes, genomic characterization of these traits has become of interest for hypertension prevention initiatives on both the individual and population levels. Here, we review advances in human genomics research of blood pressure responses to dietary sodium and potassium by focusing on 3 main areas, including the phenotypic characterization of salt sensitivity and resistance, clinical challenges in diagnosing such phenotypes, and the genomic mechanisms that may help to explain salt and potassium sensitivity and resistance. Through this process, we hope to further underline the value of leveraging genomics and broader multiomics for characterizing the blood pressure response to sodium and potassium to improve precision in lifestyle approaches for primordial and primary atherosclerotic cardiovascular disease prevention.
超过一半的美国成年人在 40 岁时患有高血压，随后患动脉粥样硬化性心血管疾病的风险增加。膳食钠和钾与高血压的病理生理学密切相关。然而，血压对膳食钠和钾的反应（分别称为血压的盐敏感性和钾敏感性）是不均匀的，并且在普通人群中呈正态分布。与血压一样，盐敏感性和钾敏感性是复杂的表型，先前的研究表明，多达 75%的个体对这种膳食矿物质的血压变化有反应。先前的研究还表明，高血压和潜在的动脉粥样硬化性心血管疾病风险增加与血压的高盐敏感性和低盐敏感性（或盐抵抗）有关。鉴于准确测量钠和钾反应表型所需的临床挑战，这些特征的基因组特征已成为个体和人群水平预防高血压的重要手段。在这里，我们通过关注 3 个主要领域，回顾了人类基因组学对膳食钠和钾对血压反应的研究进展，包括盐敏感性和抵抗的表型特征、诊断这些表型的临床挑战以及可能有助于解释盐和钾敏感性和抵抗的基因组机制。通过这个过程，我们希望进一步强调利用基因组学和更广泛的多组学来描述钠和钾对血压的反应，以提高生活方式方法在原发性和原发性动脉粥样硬化性心血管疾病预防中的精准性。
