Central Role of Sodium in Hypertension in Diabetic Subjects
Central Role of Sodium in Hypertension in Diabetic Subjects
复制标题
钠在糖尿病患者高血压中的核心作用
作者：
P. Weidmann;P. Ferrari
糖尿病和高血压之间的共同关联可能由几种机制促进。胰岛素依赖型（I型）糖尿病患者和易患肾病的患者通常具有原发性高血压的家族易感性，而非糖尿病性原发性高血压父母的正常健康后代往往具有胰岛素敏感性降低和血浆胰岛素水平升高。钠离子潴留是I型或非胰岛素依赖型（II型）糖尿病的特征性改变；可交换体Na+ (Naex)平均增加10%。这种异常出现在糖尿病的单纯期，是糖尿病与非糖尿病性原发性高血压的鉴别指标。可能的Na(+)-保留机制包括肾小球葡萄糖滤过增加，导致近端小管Na(+)-葡萄糖共运输增强，高胰岛素血症（激活几种小管Na+转运蛋白），带Na+的液体在血管外移位，一旦发生，肾功能衰竭。收缩压或平均血压与Naex呈正相关，以及高血压糖尿病患者通过利尿剂治疗去除过量Na+后血压正常化，支持了Na+滞留在糖尿病相关高血压中的发病作用。后者也可能有提高血压对Na+的敏感性。1型或2型糖尿病患者血浆中活性肾素、血管紧张素、醛固酮和儿茶酚胺的水平通常正常或较低。然而，血管对去甲肾上腺素和血管紧张素II的过度反应通常已经出现在I型或II型糖尿病的简单阶段。这可能是功能性（即细胞内电解质）和/或形态学（增生、狭窄和僵硬）血管病变的表现。糖尿病相关的钠离子潴留、血管病变以及糖尿病和原发性高血压的可能遗传易感性可能是糖尿病人群中高血压频繁发生的重要补充因素。
The common association between diabetes mellitus and hypertension may be promoted by several mechanisms. Patients with insulin-dependent (type I) diabetes and prone to develop nephropathy often have a familial predisposition for essential hypertension, whereas normotensive healthy offspring of nondiabetic essential hypertensive parents tend to have a reduced insulin sensitivity and increased plasma insulin levels. Na+ retention occurs as a characteristic alteration in type I or non-insulin-dependent (type II) diabetes; exchangeable body Na+ (Naex) is increased by 10% on average. This abnormality develops in the uncomplicated stage of diabetes and differentiates diabetic from nondiabetic essential hypertensive subjects. Possible Na(+)- retaining mechanisms include increased glomerular filtration of glucose leading to enhanced proximal tubular Na(+)-glucose cotransport, hyperinsulinemia (which activates several tubular Na+ transporters), an extravascular shift of fluid with Na+, and, once it occurs, renal failure. The pathogenetic role of Na+ retention in diabetes-associated hypertension is supported by positive correlations between systolic or mean blood pressure and Naex and by normalization of blood pressure after removal of excess Na+ by diuretic treatment in hypertensive diabetic subjects. The latter may also have an enhanced sensitivity of blood pressure to Na+. Plasma levels of active renin, angiotensin II, aldosterone, and catecholamines are usually normal or low in metabolically stable type I or type II diabetes. However, an exaggerated vascular reactivity to norepinephrine and angiotensin II commonly occurs already at uncomplicated stages of type I or type II diabetes. This may be a manifestation of functional (i.e., intracellular electrolytes) and/or morphological (proliferation, narrowing, and stiffening) vasculopathy. Diabetes-associated Na+ retention, vasculopathy, and a presumably inherited predisposition for both diabetes and essential hypertension may represent important complementary factors favoring the frequent occurrence of hypertension in the diabetic population.
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慢性高胰岛素血症会导致高血压吗？
影响因子：
3.2
作者：
Hall,JE;Coleman,TG;Mizelle,HL
通讯作者：
Mizelle,HL
培养肾细胞中胰岛素和醛固酮相互作用对 NA 和 K 转运的影响 (A6)。
影响因子：
4.8
作者：
Fidelman,ML;Watlington,CO
通讯作者：
Watlington,CO
影响因子：
15.9
作者：
DRAZNIN, B;SUSSMAN, KE;SHERMAN, NA
通讯作者：
SHERMAN, NA
影响因子：
158.5
作者：
LUETSCHER, JA;KRAEMER, FB;BRYERASH, M
通讯作者：
BRYERASH, M
预防实验性糖尿病中的肾小球毛细血管高压可避免功能性和结构性肾小球损伤。
DOI：
--
发表时间：
1986
期刊：
Journal of hypertension. Supplement : official journal of the International Society of Hypertension
影响因子：
--
作者：
Dunn,BR;Zatz,R;Rennke,HG;Meyer,TW;Anderson,S;Brenner,BM
通讯作者：
Brenner,BM