盐替代对中老年高血压患者心脏结构和心电图参数的影响。
Effect of Salt Substitution on Cardiac Structure and ECG Parameters in Middle-aged and Elderly Hypertensive Patients.
作者信息
Che Li, Zhang Ying, Chen Xia, Du Haiqing, Song Wei, Jiang Yinong
机构信息
Department of Cardiology, Central Hospital of Dalian University of Technology, 116033 Dalian, Liaoning, China.
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, 116011 Dalian, Liaoning, China.
出版信息
Rev Cardiovasc Med. 2024 Oct 31;25(11):390. doi: 10.31083/j.rcm2511390. eCollection 2024 Nov.
BACKGROUND
Salt substitution (SS) has been found to reduce blood pressure (BP). However, the impact of SS on cardiac structure, as assessed through ultrasonic cardiogram (UCG) and electrocardiograms (ECG), remains poorly understood. This study aims to evaluate the effects of SS on cardiac structure and ECG parameters.
METHODS
This 12-month prospective, multi-center, randomized, double-blind study involved hypertensive patients aged 50 to 70 years with office systolic BP (SBP) ranging from 140 to 180 mmHg and diastolic BP (DBP) ranging from 90 to 110 mmHg. A total of 352 patients were enrolled and equally randomized to either the normal salt (NS) group or SS group. Office BP measurements (OBPM) were obtained at baseline and at 3, 6, and 12 months, while home BP measurements (HBPM) were recorded at baseline, 3, 6, 9, and 12 months. Fasting blood, UCG, and ECG parameters were obtained at baseline and at the end of the study.
RESULTS
Of the 352 enrolled patients, 322 completed the study. In the SS group, the reductions in systolic OBPM, HBPM, and diastolic HBPM were significantly greater than those in the NS group. Notable cardiac parameter changes included a reduction in QT dispersion (QTd) by -5 ms (-10, 5) in the NS group and -5 ms (-15, 0) in the SS group ( = 0.001); the T wave peak-to-end (Tp-e) value was 0 ms (-5, 10) and -5 ms (-10, 0) ( < 0.001), respectively; and Tp-e/QT was 0 (-0.01, 0.02) and -0.02 (-0.04, 0) ( < 0.001), respectively. Additionally, left atrial diameter (LAD) was 0 mm (-1, 1) and -1 mm (-2, 1) ( < 0.001), and the change in left ventricular mass (LVM) was -2 g (-17.75, 11) and -7 g (-18, 6) ( = 0.035), respectively.
CONCLUSIONS
This study demonstrates that SS not only significantly decreased LAD and LVM, indicating a significant effect on cardiac structure, but also improves UCG parameters, including reductions in QTd, Tp-e, and Tp-e/QT. These findings highlight the potential of SS as a beneficial intervention in managing cardiac risks in hypertensive patients.
CLINICAL TRIAL REGISTRATION
ChiCTR1800019727. (https://www.chictr.org.cn/showproj.html?proj=31036).
背景
已发现用低钠盐替代普通盐（盐替代）可降低血压（BP）。然而，通过超声心动图（UCG）和心电图（ECG）评估，盐替代对心脏结构的影响仍知之甚少。本研究旨在评估盐替代对心脏结构和心电图参数的影响。
方法
这项为期12个月的前瞻性、多中心、随机、双盲研究纳入了年龄在50至70岁之间的高血压患者，其诊室收缩压（SBP）为140至180 mmHg，舒张压（DBP）为90至110 mmHg。总共352名患者入组并被平均随机分为普通盐（NS）组或盐替代（SS）组。在基线以及3、6和12个月时进行诊室血压测量（OBPM），在基线、3、6、9和12个月时记录家庭血压测量（HBPM）。在基线和研究结束时获取空腹血液、UCG和心电图参数。
结果
在352名入组患者中，322名完成了研究。在盐替代组中，诊室收缩压OBPM、家庭收缩压HBPM和家庭舒张压HBPM的降低幅度显著大于普通盐组。显著的心脏参数变化包括：普通盐组QT离散度（QTd）降低了-5 ms（-10，5），盐替代组降低了-5 ms（-15，0）（P = 0.001）；T波峰末间期（Tp-e）值分别为0 ms（-5，10）和-5 ms（-10，0）（P < 0.001）；Tp-e/QT分别为0（-0.01，0.02）和-0.02（-0.04，0）（P < 0.001）。此外，左心房直径（LAD）分别为0 mm（-1，1）和-1 mm（-2，1）（P < 0.001），左心室质量（LVM）的变化分别为-2 g（-17.75，11）和-7 g（-18，6）（P = 0.035）。
结论
本研究表明，盐替代不仅显著降低了左心房直径和左心室质量，表明对心脏结构有显著影响，还改善了UCG参数，包括QTd、Tp-e和Tp-e/QT的降低。这些发现突出了盐替代作为高血压患者心脏风险管理有益干预措施的潜力。
临床试验注册
ChiCTR1800019727。（https://www.chictr.org.cn/showproj.html?proj=31036）
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