Endogenous ouabain and the renin-angiotensin-aldosterone system: distinct effects on Na handling and blood pressure in human hypertension.
Endogenous ouabain and the renin-angiotensin-aldosterone system: distinct effects on Na handling and blood pressure in human hypertension.
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DOI：
10.1097/hjh.0b013e32833ea821
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发表时间：
2011-02
影响因子：
4.9
通讯作者：
Bianchi G
中科院分区：
文献类型：
--
作者：
Manunta P;Hamlyn JM;Simonini M;Messaggio E;Lanzani C;Bracale M;Argiolas G;Casamassima N;Brioni E;Glorioso N;Bianchi G
探讨肾素-血管紧张素-醛固酮系统(RAAS)和内源性哇巴因系统对肾脏钠转运和血压的影响。我们比较了301例患者在基础状态和输注生理盐水后2小时(T120)的血压和肾小管重吸收情况。经多因素调整的线性和四分位数分析后，第四个内源性哇巴因四分位数的基线平均血压(113.7±1.33 mm Hg)显著高于第一个内源性哇巴因四分位数(103.8±1.04 mm Hg)，且四分位数之间的趋势非常显著(β=0.23，P=3.53e-04)。肾素活性四分位数呈负相关，血压最高为112.5±1.26，最低为107.6±1.48，P=0.039。在急性生理盐水负荷后，血压的变化和压力-钠尿关系的斜率在整个PRA四分位数中呈负相关。钠排泄分数(Fena)从内源性哇巴因四分位数(2.35±0.17)分位数到第三个四分位数(1.90±0.14%)呈负线性趋势(P=0.05)。内源性哇巴因四分位数(>；323pmol/L)的患者在钠负荷后Fena T120升高(2.78±0.18%，P=0.007)，钠小管排斥分数增加(P=0.05)。生理盐水负荷后，血浆内源性哇巴因与内源性哇巴因水平较低时有利于钠保留、内源性哇巴因水平较高时有利于钠排泄的FENA之间存在双相关系。RAAS和内源性哇巴因系统是两个独立的、互补的系统，与血流动力学参数呈反向(RAAS)或直接(内源性哇巴因系统)关系。
To evaluate whether the renin–angiotensin–aldosterone system (RAAS) and endogenous ouabain system differently affect renal Na handling and blood pressure. Three hundred and one patients in whom we compared blood pressure, and renal Na tubular reabsorption in the basal condition and 2 h (T120) after saline infusion. Following multivariate-adjusted linear and quartiles analysis, baseline mean blood pressure (MBP) was significantly higher (113.7 ± 1.33 mmHg) in the fourth versus the first endogenous ouabain quartile (103.8 ± 1.04 mmHg) and the trend across the quartiles was highly significant (β=0.23, P =3.53e-04). In contrast, an inverse relationship was present in the renin activity (PRA) quartiles with MBP highest in the first (112.5 ± 1.26) and lowest in the fourth PRA quartile (107.6 ± 1.48, P =0.039). Following an acute saline load, changes in MBP and the slope of the pressure–natriuresis relationship were inversely related across the PRA quartiles. The fractional excretion of sodium (FENa) showed a negative linear trend going from the first to the third endogenous ouabain quartiles (2.35 ± 0.17 and 1.90 ± 0.14%, P =0.05). Patients in the fourth endogenous ouabain quartile (>323 pmol/l) showed increased FENa T120 (2.78 ± 0.18%, P < 0.01) and increased Na tubular rejection fraction (P =0.007) after Na load. After the saline load, there was a biphasic relationship between plasma endogenous ouabain and FENa favoring Na retention at low endogenous ouabain and Na excretion at high endogenous ouabain levels. The RAAS and endogenous ouabain system are two independent and complementary systems having an inverse (RAAS) or a direct (endogenous ouabain system) relationship with hemodynamic parameters.