LOW URINARY SODIUM IS ASSOCIATED WITH GREATER RISK OF MYOCARDIAL-INFARCTION AMONG TREATED HYPERTENSIVE MEN
LOW URINARY SODIUM IS ASSOCIATED WITH GREATER RISK OF MYOCARDIAL-INFARCTION AMONG TREATED HYPERTENSIVE MEN
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DOI：
10.1161/01.hyp.25.6.1144
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发表时间：
1995-06-01
期刊：
影响因子：
8.3
通讯作者：
LARAGH, JH
中科院分区：
文献类型：
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作者：
ALDERMAN, MH;MADHAVAN, S;LARAGH, JH
3高血压病患者经常推荐低钠饮食。为了确定钠摄入量与后续心血管疾病的关系，我们评估了以工作场所为基础的高血压受试者队列中参与者的经历。对2937例轻中度高血压患者停药3-4周后24小时尿钠、钾、肌酐和血浆肾素活性进行了测定。确定了这些系统治疗受试者的发病率和死亡率。男性和女性根据UNAV的性别特定四分位数进行了分层。这些阶层的受试者在种族、心血管状况、治疗前和治疗中的血压方面相似。UNaV低的受试者更瘦，排出的钾更少，血浆肾素活性更高。在平均3.8年的随访期内，共有55例心肌梗塞发生。心肌梗死和UNaV在总人口和男性中呈负相关，但在女性中没有相关性，女性只持续了9个事件。在男性中，年龄和种族调整后的心肌梗死发病率在UNaV最低和最高四分位数分别为11.5和2.5(相对风险为4.3，95%可信区间为1.7-10.6)。未观察到非心血管疾病死亡率(n=11)与UNAV之间的关系。UNaV四分位数的心肌梗死比例呈显著的线性趋势，在UNaV最低四分位数之后有一个转折点。在COX多变量分析中，LOG血浆肾素活性、年龄、收缩压和胆固醇作为连续变量以及左心室肥厚和吸烟有直接关联，UNaV(P=0.036)与这些接受治疗的高血压男性的心肌梗死发生率呈负相关。
3A sodium-reduced diet is frequently recommended for hypertensive individuals. To determine the relationship of sodium intake to subsequent cardiovascular disease, we assessed the experience of participants in a worksite-based cohort of hypertensive subjects. The 24-hour urinary excretion of sodium (UNaV), potassium, creatinine, and plasma renin activity was measured in 2937 mildly and moderately hypertensive subjects who were unmedicated for at least 3-4 weeks. Morbidity and mortality in these systematically treated subjects were ascertained. Men and women were stratified according to sex-specific quartiles of UNaV. Subjects in these strata were similar in race, cardiovascular status, and pretreatment and intreatment blood pressure. Subjects with lower UNaV were thinner, excreted less potassium, and had higher plasma renin activity. During an average 3.8 years of follow-up, a total of 55 myocardial infarctions occurred. Myocardial infarction and UNaV were inversely associated in the total population and in men but not in women, who sustained only nine events. In men, age- and race-adjusted myocarcdial infarction incidence in the lowest versus highest UNaV quartile was 11.5 versus 2.5 (relative risk, 4.3, 95% confidence interval, 1.7-10.6). No association was observed between non-cardiovascular disease mortality (n=11) and UNaV. There was a significant linear trend in proportions of myocardial infarction by UNaV quartile, with a break point after the lowest UNaV quartile. In the Cox multivariate analysis, log plasma renin activity, age, systolic pressure, and cholesterol as continuous variables as well as left ventricular hypertrophy and smoking had a direct association, and UNaV (P=.036) had an inverse, independent association with the incidence of myocardial infarction among these treated hypertensive men.