Department of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Hypertens. 2021 Aug 1;39(8):1586-1593. doi: 10.1097/HJH.0000000000002802.
Data are sparse regarding the impact of sodium and potassium intakes on serial blood pressure (BP) levels during long-term follow-up.
Among 1007 Coronary Artery Risk Development in Young Adults participants (mean age, 30.2 years; 53% blacks; 57% women) who had at least two 24-h urine samples collected at year 5 (Y5) examination, we assessed associations of urinary sodium and potassium excretions with BP trends and incident hypertension in the subsequent 25 years. Participants were classified by sex-specific medians for averaged 24-h urinary excretions: lower sodium and higher potassium (Na-Lo-K-Hi); higher sodium and lower potassium (Na-Hi-K-Lo); and others.
In the adjusted generalized estimating equation model, SBP and DBP greatly increased in the Na-Hi-K-Lo group (n = 185) compared with the Na-Lo-K-Hi group (n = 185), with statistically significant BP differences at Y20, Y25, and Y30 (mean SBP, 3.93, 4.94, and 4.88 mmHg, respectively; and mean DBP, 4.70, 4.95, and 4.59 mmHg, respectively). During 25-year follow-up, among 926 participants without prevalent hypertension by Y5, 381 (41.1%) developed hypertension. In the adjusted Cox proportional hazards model, the Na-Hi-K-Lo group had hazard ratio (95% confidence interval), 1.45 (1.00-2.10) for incident hypertension compared with the Na-Lo-K-Hi group. The association with incident hypertension was predominant in blacks and white women (race--sex interaction, P = 0.03). Sodium-to-potassium ratio and sodium excretion were positively, whereas potassium excretion was inversely, associated with incident hypertension (all P trend <0.05).
Our findings highlight the importance of dietary sodium reduction and higher potassium intake for hypertension prevention among young adults.
关于长期随访期间钠和钾摄入量对连续血压（BP）水平的影响，相关数据较为匮乏。
在至少有两次 24 小时尿液样本在第 5 年（Y5）检查时收集的 1007 名冠状动脉风险发展在年轻人参与者（平均年龄 30.2 岁；53%黑人；57%女性）中，我们评估了尿钠和钾排泄与随后 25 年血压趋势和高血压事件的相关性。参与者根据 24 小时尿液平均排泄的性别特异性中位数进行分类：低钠高钾（Na-Lo-K-Hi）；高钠低钾（Na-Hi-K-Lo）；和其他。
在调整后的广义估计方程模型中，与 Na-Lo-K-Hi 组（n=185）相比，Na-Hi-K-Lo 组（n=185）的 SBP 和 DBP 大幅升高，在 Y20、Y25 和 Y30 时存在统计学显著的 BP 差异（平均 SBP 分别为 3.93、4.94 和 4.88mmHg；平均 DBP 分别为 4.70、4.95 和 4.59mmHg）。在 25 年的随访期间，在 Y5 时没有高血压的 926 名参与者中，有 381 名（41.1%）发生了高血压。在调整后的 Cox 比例风险模型中，与 Na-Lo-K-Hi 组相比，Na-Hi-K-Lo 组发生高血压的风险比（95%置信区间）为 1.45（1.00-2.10）。这种与高血压事件的关联在黑人和白人女性中更为显著（种族-性别交互作用，P=0.03）。钠钾比和钠排泄与高血压事件呈正相关，而钾排泄与高血压事件呈负相关（所有 P 趋势<0.05）。
我们的研究结果强调了减少年轻成年人饮食中钠摄入和增加钾摄入对预防高血压的重要性。
