Study of pathogenesis of salt-sensitive hypertension: Japan-US cooperative study

在非调节剂的诊断标准方面，G.H.Williams等人在正常肾素原发性高血压(NR-EHT)的白人患者中，伴随着未能调节肾上腺和肾血管对氯化钠摄入量变化的反应。我们研究了非调节剂在日本NR-EHT患者中的发生率，以及非调节剂与盐敏感性的关系。21例HET患者中有18例诊断为NR-EHT。对5名血压正常的受试者进行的初步研究表明，该标准适用于日本受试者。进行氯化钠平衡研究，每天250 Meg氯化钠，持续一周(高钠期)，然后每天10 Meg氯化钠，持续一周(低钠期)，并在每个周期的最后一天检测肾血管和肾上腺对血管紧张素II(AII)3.0 ng/kg/min的反应。对氨基马尿酸清除量<120…测定AII对肾血浆流量的影响高钠期大于1.73m^2/ml/min为肾血管系统的非调节剂。血浆醛固酮浓度(PAC)在低钠期升高<150pg/ml被认为是肾上腺的非调节剂。在日本NR-EHT患者中，肾血管反应和肾上腺反应中非调节剂的发生率分别为16.7%(3/18)和61.1%(11/18)。只有3名患者同时被这两种标准诊断为非调节剂。日本人肾上腺反应诊断为非调节剂的发生率与美国相似。通过钠盐平衡研究，调理剂与非调理剂对RPF、PAC、血清电解质、红细胞钠转运系统、血小板AII受体和钙调节激素的变化无显著差异。盐敏感性(平均血压从高钠期到低钠期的变化)与肾上腺对AII的反应从高钠期到低钠期的变化呈负相关，而与肾血管反应、钠转运系统、血小板AII受体、钙调节激素的变化无关。在肾上腺对外源性AII的反应诊断为NR-EHT的日本患者中，非调节剂的发生率为61%，与美国相似。肾上腺的调节可能在NR-EHT患者的盐敏感性中起一定作用。较少

On the diagnostic criteria of non-modulator, who concomitantly fails to modulate the adrenal and the renovascular responses to change in sodium chloride intake, in white patients with normal-renin essential hypertension (NR-EHT) by G.H.Williams et al. (Harvard Medical School, Boston, MA), we examined the incidence of non-modulator in Japanese patients with NR-EHT and the relation between non-modulation and salt sensitivity. Eighteen out of 21 patients with HET were diagnosed as NR-EHT. A preliminary study performed on 5 normotensive sudjects showed the criteria were applicable to Japanese subjects. Sodium chloride balance study, 250 mEg NaCl a day for a week (high sodium period) followed by 10 mEg NaCl a day for a week (low sodium period), were performed and on the last day of each period the renovascular and the adrenal responses to 3.0 ng/Kg/min of angiotensin II(AII) were examined. The decrease in renal plasma flow (RPF) by AII measured by para-aminohippurate clearance less than 120 … More ml/min/1.73m^2 in the high sodium period was designated as non-modulator of the renovascular system. The increase in plasma aldosterone concentration(PAC) by AII less than 150 pg/ml in the low sodium period was designated as non-modulator of the adrenal gland. The incidence of non-modulator in Japanese patients with NR-EHT was 16.7%(3/18) by the renovascular response or 61.1%(11/18) by the adrenal response. There were only three patients who were diagnosed non-modulator by the both criteria concomitantly. The incidence of non-modulator in Japanese diagnosed by the adrenal response was similar to that in the United States. There was no significant differences in changes of RPF, PAC, serum electrolytes, erythrocytic Na transport systems, platelet AII receptor and Ca-regulating hormones with sodium chloride balance study between modulator and non-modulator. Salt sensitivity (change in mean blood pressure from high to low sodium period) showed negative correlation with changes in the adrenal response to AII from high to low sodium period, but not with those in renovascular response, Na transport systems, platelet AII receptor, Ca-regulating hormones.In summary, it was suggested that in Japanese patients with NR-EHT modulation of adrenal gland and renovascular system was independent each other. The incidence of non-modulator in Japanese patients with NR-EHT diagnosed by adrenal response to extrinsic AII was 61% and similar to that in the United States. Modulation of the adrenal gland may play some role on salt sensitivity in patients with NR-EHT. Less