Uzu T, Nishimura M, Fujii T, Takeji M, Kuroda S, Nakamura S, Inenaga T, Kimura G
Division of Nephrology, National Cardiovascular Center, Suita, Osaka, Japan.
J Hypertens. 1998 Dec;16(12 Pt 1):1745-8. doi: 10.1097/00004872-199816120-00006.
Recently, we found that sodium restriction restored the circadian rhythm of blood pressure from non-dippers to dippers in patients with a sodium-sensitive type of essential hypertension. In the present study, we investigated the effects of sodium restriction on the circadian blood pressure rhythm in patients with primary aldosteronism, a typical sodium-sensitive form of secondary hypertension.
We performed 24 h blood pressure monitoring in eight patients with primary aldosteronism due to unilateral adenoma (Conn's syndrome) during normal-sodium (7-12 g/day of NaCl) and low-sodium (1-3 g/day) diets, and after adrenalectomy.
Sodium restriction lowered the 24 h mean arterial pressure from 116+/-14 to 109+/-12 mmHg (P< 0.01). During a normal-sodium diet, there was no change in systolic, diastolic and mean arterial pressures during the night-time compared with the daytime. In contrast, during a low-sodium diet, all night-time pressure values were significantly lower than those in the daytime. After adrenalectomy, the night-time pressures in patients on a normal-sodium diet were lower than those of the daytime. The nocturnal mean arterial pressure fall was increased by sodium restriction and adrenalectomy.
These results indicate that the circadian rhythm of blood pressure was disturbed in patients with primary aldosteronism who maintained a relatively high sodium intake. Both adrenalectomy and sodium restriction restored a nocturnal dip in blood pressure in primary aldosteronism. Therefore, sodium restriction affects the circadian blood pressure rhythm in sodium-sensitive types of hypertension, not only in primary hypertension, but also in secondary hypertension.
最近，我们发现限钠可使钠敏感性原发性高血压患者的血压昼夜节律从非勺型恢复为勺型。在本研究中，我们调查了限钠对原发性醛固酮增多症患者昼夜血压节律的影响，原发性醛固酮增多症是继发性高血压的一种典型钠敏感形式。
我们对8例因单侧腺瘤（Conn综合征）导致的原发性醛固酮增多症患者在正常钠（氯化钠7 - 12克/天）和低钠（1 - 3克/天）饮食期间以及肾上腺切除术后进行了24小时血压监测。
限钠使24小时平均动脉压从116±14降至109±12 mmHg（P<0.01）。在正常钠饮食期间，夜间收缩压、舒张压和平均动脉压与白天相比无变化。相比之下，在低钠饮食期间，所有夜间血压值均显著低于白天。肾上腺切除术后，正常钠饮食患者的夜间血压低于白天。限钠和肾上腺切除术均增加了夜间平均动脉压下降幅度。
这些结果表明，原发性醛固酮增多症患者在维持相对高钠摄入时血压昼夜节律受到干扰。肾上腺切除术和限钠均可使原发性醛固酮增多症患者恢复夜间血压下降。因此，限钠不仅影响原发性高血压，也影响继发性高血压中钠敏感性高血压类型的昼夜血压节律。
