Salt sensitivity and its implication in clinical practice.
Salt sensitivity and its implication in clinical practice.
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DOI：
10.1016/j.ihj.2017.10.006
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发表时间：
2018-07
影响因子：
1.5
通讯作者：
Jain R
中科院分区：
文献类型：
--
作者：
Mishra S;Ingole S;Jain R
高血压（HTN）是一种复杂的多因素疾病，被认为是中风、心力衰竭、缺血性心脏病和肾功能不全的最重要的可改变的危险因素之一。在过去的世纪，盐及其与HTN和心血管（CV）死亡率的联系一直是严格的科学审查的主题。现在有一个共识，不同的人有不同的敏感性血压（BP）的影响，盐和这种敏感性被称为作为盐敏感性。据信，几种肾和肾外机制发挥了作用。RAAS、Rac 1-MR-Sgk 1-NCC/ENaC通路、SNS-GR-WNK 4-NCC通路的活性减弱、膜离子转运障碍、炎症反应和Na+/Ca 2+交换异常是盐敏感性HTN的病理生理基础。虽然限盐绝对有益，但最近的观察表明，阿齐沙坦治疗可通过选择性降低肾近端小管Na+/H+交换来改善盐敏感性。这鼓励了识别和治疗性解决人类盐敏感表型的未来潜在益处。
Hypertension (HTN) is a complex multi-factorial disease and is considered one of the foremost modifiable risk factors for stroke, heart failure, ischemic heart disease and renal dysfunction. Over the past century, salt and its linkage to HTN and cardiovascular (CV) mortality has been the subject of intense scientific scrutiny. There is now consensus that different individuals have different susceptibilities to blood pressure (BP)-raising effects of salt and this susceptiveness is called as salt sensitivity. Several renal and extra-renal mechanisms are believed to play a role. Blunted activity of the renin–angiotensin–aldosterone system (RAAS), adrenal Rac1-MR-Sgk1-NCC/ENaC pathway, renal SNS-GR-WNK4-NCC pathway, defect of membrane ion transportation, inflammation and abnormalities of Na+/Ca2+ exchange have all been implicated as pathophysiological basis for salt sensitive HTN. While salt restriction is definitely beneficial recent observation suggests that treatment with Azilsartan may improve salt sensitivity by selectively reducing renal proximal tubule Na+/H+ exchange. This encourages the future potential benefits of recognizing and therapeutically addressing the salt sensitive phenotype in humans.