Diagnostic tools for hypertension and salt sensitivity testing.
Diagnostic tools for hypertension and salt sensitivity testing.
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DOI：
10.1097/mnh.0b013e32835b3693
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发表时间：
2013-01
影响因子：
3.2
通讯作者：
Jose PA
中科院分区：
文献类型：
--
作者：
Felder RA;White MJ;Williams SM;Jose PA
世界上三分之一的人口患有高血压，近 50% 的中风或冠心病死亡病例都是由高血压造成的。这些统计数据没有区分盐敏感型和耐盐性高血压，也没有包括对盐敏感的血压正常的人，尽管与血压无关的盐敏感度是心血管和其他疾病（包括癌症）的危险因素。这篇综述描述了针对盐敏感性的新的个性化诊断工具。盐摄入量与心血管风险之间的关系不是线性的，而是符合J形曲线关系。因此，低盐饮食可能并不对每个人都有益，而且可能反而会增加某些人的血压。目前盐敏感性的替代标记不够灵敏或特异性。尿液中的检测可以作为盐敏感性的替代标志物，且周转时间短，包括肾近端小管细胞、外泌体和尿液中脱落的 microRNA。准确测试盐敏感性不仅费力而且昂贵，而且患者依从性低。血压正常但对盐敏感的患者无法在办公室环境中进行诊断，也没有针对盐敏感性的实验室测试。盐敏感性的尿液替代标记物正在开发中。
One-third of the world’s population has hypertension and it is responsible for almost 50% of deaths from stroke or coronary heart disease. These statistics do not distinguish salt-sensitive from salt-resistant hypertension or include normotensives who are salt-sensitive even though salt sensitivity, independent of blood pressure, is a risk factor for cardiovascular and other diseases, including cancer. This review describes new personalized diagnostic tools for salt sensitivity. The relationship between salt intake and cardiovascular risk is not linear, but rather fits a J-shaped curve relationship. Thus, a low-salt diet may not be beneficial to everyone and may paradoxically increase blood pressure in some individuals. Current surrogate markers of salt sensitivity are not adequately sensitive or specific. Tests in the urine that could be surrogate markers of salt sensitivity with a quick turn-around time include renal proximal tubule cells, exosomes, and microRNA shed in the urine. Accurate testing of salt sensitivity is not only laborious but also expensive, and with low patient compliance. Patients who have normal blood pressure but are salt-sensitive cannot be diagnosed in an office setting and there are no laboratory tests for salt sensitivity. Urinary surrogate markers for salt sensitivity are being developed.