Luft F C, Weinberger M H
Franz Volhard Clinic, Rudolf Virchow University Hospital, Free University of Berlin, Germany.
Am J Clin Nutr. 1997 Feb;65(2 Suppl):612S-617S. doi: 10.1093/ajcn/65.2.612S.
Blood pressure responses to increases and decreases in dietary salt intake are heterogeneous. In some hypertensive individuals, decreases in blood pressure with salt restriction are clinically significant and approach that achieved with medication. In others, little or no change in blood pressure occurs, whereas in still others, blood pressure may actually increase with salt restriction. The heterogeneous responses are partly acquired and involve the influences of age, the intake of other electrolytes, and the influence of certain medications. Genetic predisposition may also play a substantial role because salt sensitivity is increased in black individuals and in persons with non-insulin-dependent diabetes mellitus. Some uncommon but readily diagnosed salt-sensitive genetic syndromes, such as glucocorticoid-remediable aldosteronism and Liddle syndrome, have been identified. Short-term volume expansion and contraction and longer-term dietary interventions appear to be reproducible and may be used to identify salt-sensitive and salt-resistant individuals; however, these maneuvers are cumbersome and cannot be used on a large scale. Molecular genetic techniques for identifying individuals with salt-sensitive and salt-resistant essential hypertension are not yet available, but if the putative gene polymorphisms are identified, such techniques may replace the current trial-and-error methods.
血压对饮食中盐摄入量增减的反应是异质性的。在一些高血压个体中，限盐后血压下降具有临床意义，且接近药物治疗所达到的效果。在另一些个体中，血压几乎没有变化，而在其他一些个体中，限盐后血压实际上可能会升高。这种异质性反应部分是后天获得的，涉及年龄、其他电解质摄入量以及某些药物的影响。遗传易感性也可能起重要作用，因为黑人个体和非胰岛素依赖型糖尿病患者的盐敏感性增加。一些罕见但易于诊断的盐敏感遗传综合征，如糖皮质激素可治性醛固酮增多症和利德尔综合征，已被识别。短期的容量扩张和收缩以及长期的饮食干预似乎具有可重复性，可用于识别盐敏感和盐抵抗个体；然而，这些操作很繁琐，无法大规模应用。用于识别盐敏感和盐抵抗原发性高血压个体的分子遗传学技术尚未可用，但如果确定了假定的基因多态性，此类技术可能会取代目前的试错方法。
