盐替代对中老年高血压患者动态血压、肾功能及炎症的影响
Effect of Salt Substitution on Ambulatory Blood Pressure, Kidney Function and Inflammation in Middle-Aged and Elderly Hypertensive Patients.
作者信息
Che Li, Fu Jiayu, Zhang Ying, Cheng Yunpeng, Liu Yan, Song Wei, Jiang Yinong
机构信息
Department of Cardiology, Central Hospital of Dalian University of Technology, 116033 Dalian, Liaoning, China.
Yingkou Central Hospital, 115003 Yingkou, Liaoning, China.
出版信息
Rev Cardiovasc Med. 2024 May 8;25(5):158. doi: 10.31083/j.rcm2505158. eCollection 2024 May.
BACKGROUND
Low-sodium (LS) salt substitution is recognized for its potential to reduce blood pressure (BP), but most research relies on office BP measurement (OBPM). There is a lack of data on salt substitution's effect on target organs, such as the kidney as measured by the urine albumin-to-creatinine ratio (UACR), and its impact on inflammatory cytokines, particularly high-sensitivity C-reactive protein (hs-CRP). To evaluate the effect of LS salt substitution on ambulatory BP measurement (ABPM), kidney function, and inflammation in middle-aged and elderly hypertensive patients.
METHODS
In this 12-month prospective, multi-center, randomized, double-blind study, 352 hypertensive patients were randomly assigned to the normal salt (NS) group (n = 176) or the LS group (n = 176) at a 1:1 ratio. ABPM, fasting blood, and morning first spot urine samples were obtained at baseline and the endpoint.
RESULTS
Of the 352 patients, 322 completed all follow-up surveys, and 301 underwent ABPM. In the LS roup, significant reductions were observed in 24-hr systolic BP (-2.3 mmHg), 24-hr diastolic BP (-1.5 mmHg), daytime systolic BP (-2.6 mmHg), daytime diastolic BP (-1 mmHg), and nighttime systolic BP (-0.1 mmHg) compared to the NS group (all 0.05). However, the change in nighttime diastolic BP was not statistically significant (-0.3 vs. 1.1 mmHg, = 0.063). Additionally, the LS group showed a more substantial decrease in UACR (-2.05 vs. -7.40 µg/mg, = 0.004) and hs-CRP (-0.06 vs. -0.24 mg/L, = 0.048) compared to NS.
CONCLUSIONS
LS salt substitution significantly decreased ABPM, suggesting a notable impact on hypertension. Furthermore, it demonstrated a protective impact on kidney function, as evidenced by changes in UACR. Additionally, LS salt substitution appeared to reduce inflammation, indicated by the decrease in hs-CRP levels.
CLINICAL TRIAL REGISTRATION
The study was registered in the Chinese clinical trial registry (registration number: ChiCTR1800019727).
背景
低钠盐替代因其降低血压（BP）的潜力而受到认可，但大多数研究依赖于诊室血压测量（OBPM）。关于盐替代对靶器官的影响，如通过尿白蛋白与肌酐比值（UACR）测量的肾脏，以及其对炎症细胞因子，特别是高敏C反应蛋白（hs-CRP）的影响，数据尚缺。旨在评估低钠盐替代对中老年高血压患者动态血压测量（ABPM）、肾功能和炎症的影响。
方法
在这项为期12个月的前瞻性、多中心、随机、双盲研究中，352例高血压患者按1:1的比例随机分为正常盐（NS）组（n = 176）或低钠盐（LS）组（n = 176）。在基线和终点时采集ABPM、空腹血和晨尿首次晨尿样本。
结果
352例患者中，322例完成了所有随访调查，301例进行了ABPM。与NS组相比，LS组的24小时收缩压（-2.3 mmHg）、24小时舒张压（-1.5 mmHg）、日间收缩压（-2.6 mmHg）、日间舒张压（-1 mmHg）和夜间收缩压（-0.1 mmHg）均显著降低（均P<0.05）。然而，夜间舒张压的变化无统计学意义（-0.3 vs. 1.1 mmHg，P = 0.063）。此外，与NS组相比，LS组的UACR（-2.05 vs. -7.40 μg/mg，P = 0.004）和hs-CRP（-0.06 vs. -0.24 mg/L，P = 0.048）下降幅度更大。
结论
低钠盐替代显著降低了ABPM，提示对高血压有显著影响。此外，如UACR的变化所示，其对肾功能有保护作用。此外，低钠盐替代似乎减轻了炎症，表现为hs-CRP水平降低。
临床试验注册
该研究已在中国临床试验注册中心注册（注册号：ChiCTR1800019727）。
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