Gavras H, Waeber B, Kershaw G R, Liang C S, Textor S C, Brunner H R, Tifft C P, Gavras I
Hypertension. 1981 Jul-Aug;3(4):441-7. doi: 10.1161/01.hyp.3.4.441.
Sixteen patients with refractory hypertension were submitted to vigorous sodium depletion while cardiovascular homeostasis was monitored with measurements of hormonal and hemodynamic parameters and repeat saralasin tests. This regimen resulted in a negative sodium balance by an average of 300 mEq. The loss of sodium closely correlated to the decrease of body weight (r = 0.70, p less than 0.005). Blood pressure (BP) decreased from 176/166 +/- 8/3 to 155/109 +/-6/3 mm Hg. There was a significant correlation between percent increments in plasma renin activity (PRA) and the rise in plasma norepinephrine (r = 0.68, p less than 0.05) and a close negative correlation between percent increase in PRA and the ratio of fall in mean blood pressure (MAP) per unit of weight loss (r = -0.73, p less than 0.005). Thus, patients with the least percent increase in PRA demonstrated the greatest fall in BP per unit of weight loss, indicating that relative rather than absolute elevation of renin may be the factor limiting antihypertensive efficacy of sodium depletion. Sodium depletion induced increase in peripheral resistance and decrease in cardiac output, both mostly attributable to relative hyperreninemia. Indeed, the adverse hemodynamic changes were reversed by angiotensin inhibition, during which BP normalized. It is concluded that vigorous sodium depletion complemented by angiotensin blockade or suppression with sympatholytic agents improves management of otherwise refractory hypertension.
16例顽固性高血压患者接受了严格的钠耗竭治疗，同时通过测量激素和血流动力学参数以及重复进行沙拉新试验来监测心血管稳态。该治疗方案导致平均钠平衡为负300 mEq。钠的丢失与体重减轻密切相关（r = 0.70，p < 0.005）。血压（BP）从176/166 ± 8/3降至155/109 ± 6/3 mmHg。血浆肾素活性（PRA）的百分比增加与血浆去甲肾上腺素的升高之间存在显著相关性（r = 0.68，p < 0.05），PRA的百分比增加与每单位体重减轻时平均血压（MAP）下降的比率之间存在密切的负相关（r = -0.73，p < 0.005）。因此，PRA增加百分比最小的患者每单位体重减轻时血压下降最大，这表明肾素的相对而非绝对升高可能是限制钠耗竭降压效果的因素。钠耗竭导致外周阻力增加和心输出量减少，两者主要归因于相对高肾素血症。事实上，血管紧张素抑制可逆转不良的血流动力学变化，在此期间血压恢复正常。结论是，通过血管紧张素阻断或用抗交感神经药物抑制来补充严格的钠耗竭可改善对其他方面难治性高血压的治疗。
