Effects of Replacing Sodium Intake in Subjects on a Low Sodium Diet: A Crossover Study

Eighty-eight untreated subjects (mean age 58.6 ± 1.1 years; 73 males and 15 females) with diastolic blood pressure between 90 and 100 mmHg were recruited to the study. Subjects were seen fortnightly and after four pre-diet visits were randomised into a normal sodium intake group (44 subjects receiving > 80 mmol sodium daily in the diet plus 80 mmol of sodium supplement as eight slow release sodium chloride tablets daily) or a low sodium intake group (44 subjects receiving < 80 mmol sodium daily in the diet plus eight slow release sodium chloride placebo tablets daily). Eight weeks later, subjects crossed over to the alternate tablets while continuing with the reduced sodium diet for another period o f 8 weeks. The difference in urine sodium between the low sodium phase and the normal sodium phase was 67 2 4 mmol/day independent of the order in which the treatments were given: the corresponding difference in urine potassium excretion was 1.2 5 1.4 mmol/day and was not significant.

The differences in systolic and diastolic blood pressures between the low sodium and normal sodium phases for all 88 subjects were 3.6 ± 0.7 mmHg (95% confidence intervals 2.2-5.0) and 2.1 ± 0.4 mmHg (95% confidence intervals 1.3-2.9) respectively, and were independent of the order in which treatments were given (p < 0.005). On the other hand, comparison of the blood pressures of the two cohorts of subjects as parallel groups during the first test phase revealed that the falls in pressure were greater by 5.3 ± 1.4 (95% confidence intervals 2.7-8.1) mmHg (systolic) and 3.4 ± 0.8 (95% confidence intervals 1.8-5.0) mmHg (diastolic) in subjects with low sodium intake compared with those with normal sodium intake. These differences in blood pressure reduction obtained by analysis of the crossover study and of the parallel group study were not significant, with clear overlap of the 95% confidence intervals. Moderate dietary salt restriction causes reductions in blood pressure and around 3.5-5.5 mmHg (systolic) and 2-3.5 mmHg (diastolic) of these falls can be attributed specifically to reduction o f sodium chloride intake.     

早期原发性高血压左心室舒张功能的超声心动图评价

目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。     

盐敏感性加重高血压患者血管内皮功能的损伤

目的探讨原发性高血压患者盐敏感性与血管内皮功能障碍的关系。方法根据急性静脉盐水负荷和呋喃苯胺酸缩容试验将204例原发性高血压患者分为盐敏感性高血压(SS)(n=96)和盐不敏感性高血压(NSS)(n=108),46例正常人设为对照组。采用双抗体夹心固相免疫法测定血清血管性血友病因子(v WF)、放免法测定内皮素1水平,用超声诊断仪测定肱动脉血流介导的内皮依赖性血管舒张功能(FMD)。结果SS组vWF、内皮素1较NSS组高(P<0.05),FMD较NSS组为低(P<0.05)。相关分析显示SS组FMD与血清v WF、内皮素1水平呈负相关(r分别为-0.362,-0.431,均P<0.01),而NSS组FMD与v WF、内皮素1无相关(r分别为-0.146,-0.172,P>0.05)。多元线性回归分析显示,盐敏感性(β=-0.193)、v WF(β=-0.286)、内皮素1(β=-0.322)与FMD独立相关(均P<0.01)。结论盐敏感性会加重高血压患者血管内皮功能的损伤。     

Left Ventricular mass Regression with Amlodipine in Elderly Hypertensives

We evaluated effect of amlodipine therapy on left ventricular (LV) mass and function indices in 34 elderly hypertensives having echocardiographic evidence of left ventricular hypertrophy (LVH). LV mass and LV function indices were evaluated before and after 4 months of effective amlodipine therapy. Fourteen patients completed the study. Blood pressure was effectively controlled in all the patients; dose requirement of amlodipine being 5 mg/day in 8 and 10 mg/day in 6 patients. We found significant regression of LV mass indices such as thickness of interventricular septum (IVS) and left ventricular posterior wall (LVPW), and LV mass index after 4 months of amlodipine therapy. However, LV function indices did not alter following treatment. In conclusion, amlodipine therapy besides effectively contrlolling BP in elderly hypertensives, produced significant regression of LV mass indices without affecting the LV function.     

高血压合并代谢紊乱及对心肾血管的影响

目的观察高血压合并代谢紊乱的状况及其对心肾血管的影响。方法住院高血压患者1033例分为单纯高血压组102例、高血压合并血脂紊乱组117例、高血压合并腹型肥胖组119例、高血压合并糖尿病组135例和高血压合并代谢综合征组(MS)560例。应用彩色多普勒超声检测心脏和血管的结构和功能,应用免疫比浊法测定微量白蛋白尿(MAU),评估心肾血管损害情况。结果(1)住院病人中单纯高血压仅为9·9%,90·1%的高血压患者合并有代谢紊乱。(2)高血压合并腹型肥胖时左室质量(LVM)和左室质量指数(LVMI)显著高于高血压合并血脂紊乱组、高血压合并糖尿病组和高血压合并MS组(P<0·05或P<0·01)。高血压合并糖尿病组及高血压合并MS组的颈动脉斑块检出率分别为65·7%和58·5%,明显高于高血压合并血脂紊乱组(35·0%)和高血压合并腹型肥胖组(45·8%)(P<0·05或P<0·01);高血压合并糖尿病组及高血压合并MS组的MAU阳性率(分别为48·0%和41·8%)显著高于单纯高血压组(9·5%)、高血压合并血脂紊乱组(25%)和高血压合并腹型肥胖组(22·4%)(P<0·05或P<0·01)。结论超过90%的高血压住院患者合并有不同形式的代谢紊乱,高血压合并腹型肥胖将加重左室肥厚(LVH),合并糖尿病和MS加重大血管及微血管的损害,纠正代谢紊乱对高血压的治疗有重要意义。     

阿托伐他汀对血脂正常高血压患者血管内皮功能的影响

目的探讨血脂正常高血压患者应用不同剂量阿托伐他汀治疗后对内皮依赖性血管舒张功能的影响。检验阿托伐他汀有无“降脂外作用”的假说。方法血脂正常高血压患者55例随机分成阿托伐他汀10mg治疗组25例,阿托伐他汀20mg治疗组30例,正常对照组25例。应用超声检测肱动脉血流介导的血管舒张功能(FMD)和内皮非依赖性血管舒张功能(EID),比较治疗4周前后的变化。结果血脂正常高血压组患者内皮功能与健康对照组相比显著降低。阿托伐他汀10mg组治疗前后FMD分别为(7.5±2.7)%与(11.5±3.1)%,P<0.05,EID为(16.9±4.5)%与(17.4±5.3)%,P>0.05,阿托伐他汀20mg组治疗前后FMD分别为(7.3±3.4)%与(14.7±2.5)%,P<0.01,EID为(17.1±5.5)%与(18.2±5.6)%,P>0.05。阿托伐他汀10mg组与20mg组治疗后比较,以20mg组FMD改善明显(P<0.05)。结论阿托伐他汀具有降脂以外的改善内皮功能的作用,且具有量效关系。     

High Risk of Cerebro-cardiovascular Morbidity in Well Treated Male Hypertensives

Abstract In a retrospective study of 121 hypertensives aged 40–59 years in comparison with 138 controls selected from the population in the same primary care district, male hypertensives had a high odds ratio of cerebro-cardiovascular (CCV) diseases even when their blood pressure had been well treated. The estimated odds ratio (corrected for small numbers) was 13.7 (2.5–76.7). In female hypertensives there was a trend towards more CCV diseases than in their controls. Although the hypertensives' blood pressure was reduced in accordance with what has been internationally accepted, their values were still at least 10–11 mmHg higher than those of the controls. A reduction of this magnitude may be accomplished by (further) weight reduction and, probably, intervention with factors linked to obesity. This may be one way to reduce the excess risk in hypertensives.     

高血压煤矿工人血压正常子女的相关危险因素分析

目的通过对2007年以来高血压煤矿工人其血压正常子女的各种变化的研究分析,旨在为矿工高血压患者其血压正常子女的预防及保健工作提供参考。方法以2007年以来枣庄矿业集团陶庄矿、山家林矿、枣庄矿的部分高血压矿工血压正常子女和非高血压矿工血压正常子女为研究对象。把父母单方高血压的血压正常子女设为A组,共调查100人;父母双方高血压的血压正常子女设为B组,共调查120人;非高血压矿工血压正常子女设为c组,共调查105人。由经专业培训调查人员指导入选对象填写统一设计信息表,并对入选对象进行血压测量,心脏、颈动脉和肾动脉彩色多普勒超声检查,了解左心的结构和功能改变,颈动脉内-中膜及斑块情况和肾动脉血流各种参数,并进行葡萄糖耐量试验及胰岛素释放试验。结果A组、B组分别与C组比较,血压明显升高,差异有统计学意义（P〈0．05）,A组与B组比较差异无统计学意义（P〉0．05）。A组、B组分别与c组比较,LAD、AOD、IVS、LVPW、LVW、LVMI明显高于C组,差异有统计学意义（P〈0．05）,且B组与A组比较差异亦有统计学意义（P〈0．05）。反映左室舒张功能的指标E／A,A组与B组明显高于C组（P〈0．05）,且B组与A组比较,差异亦有统计学意义（P〈0．05）。反映左室收缩功能的指标LVEF及LVD三组比较差异无统计学意义（P〉0．05）。A组、B组分别与C组比较,颈动脉斑块积分、左颈总动脉IMT及右颈总动脉IMT明显升高,差异有统计学意义（P〈0．05）,但A组与B组比较差异无统计学意义（P〉0．05）。结论（1）煤矿工人高血压患者其血压正常子女的血压呈现明显升高趋势。（2）煤矿工人高血压患者其血压正常子女左心的结构和功能明显改变,颈动脉内-中膜及斑块情况和肾动脉血流各种参数明显改变,且存在胰岛素抵抗     

Salivary markers of hepato-metabolic comorbidities in pediatric obesity

Background

The pediatric obesity epidemic calls for the noninvasive detection of individuals at higher risk of complications.

Sodium Chloride Preference and Recognition Threshold in Normotensive Subjects on High and Low salt Diet

Young adult volunteers were placed on two week periods of high and low-salt diets following dietetic counselling and using normally available foodstuffs. Changes in sodium recognition threshold, salivary and urinary electrolytes and preference for NaCl, NaCl/KCl (1:1) mix and monosodium glutamate were measured during the high- and low-salt diet periods and during two-week control periods with subjects on their usual diet. Sodium preference was defined as the sodium concentration of unsalted tomato juice following ad libitum addition of a sodium salt till the most preferred taste was achieved. Subjects served as their own controls across the dietary periods in a cross-over design. While sodium excretion on the low-salt diet was significantly less than that on the high-salt diet, there were no significant changes in blood pressure, sodium recognition threshold, body weight or salivary electrolytes between these dietary periods. There was a significant increase in preference for NaCl, NaCl/KCl mix and monosodium glutamate on the high-salt diet when compared to the low-salt diet period. In all dietary periods less sodium was added to the unsalted tomato juice with monosodium glutamate than with NaCl/KCl and less sodium was added with the NaCl/KCl mix than with the NaCl. This study demonstrates that relatively short periods of increased sodium intake result in an increase in sodium preference in the absence of changes in salivary electrolytes or recognition threshold.     

Mortality and Morbidity in Treated Hypertensive Type 2 Diabetic Patients with Micro- or Macroproteinuria

In order to describe the natural history of high risk diabetic patients treated for hypertension we have followed a sequential sample of 100 hypertensive Type 2 diabetic patients with elevated urinary protein excretion (≥60 mg 24 h⁻¹) for a period of 1–7 years. Antihypertensive treatment was instituted in all patients and, in addition, the patients were offered the possibility of participation in an intensified antihypertensive therapy programme. After a mean follow-up of 4 years overall mortality was 13 %. Nineteen percent of all patients experienced a cardiovascular event and 7 % a cerebrovascular event. In conclusion, in this study the overall mortality was lower that previously reported in proteinuric Type 2 diabetic patients. Antihypertensive treatment may account for this outcome.     

Characterization of Salivary Microbiota in Patients with Atherosclerotic Cardiovascular Disease: A Case-Control Study

Aims: Oral bacteria have been reported to be associated with the pathogenesis of atherosclerosis; however, the relationship between the oral microbiota and atherosclerosis remains unclear. The present study aimed to investigate whether or not salivary microbiota of patients with atherosclerotic cardiovascular disease (ACVD) differs from that of subjects without ACVD, and to characterize the salivary microbiota of patients with ACVD. Methods: This study included 43 patients with ACVD and 86 age- and sex-matched non-ACVD individuals. 16S rRNA metagenomic analysis were performed using DNA isolated from the saliva samples of the participants. To select unique operational taxonomic unit (OTU) sets of ACVD, we conducted the random forest algorithm in machine learning, followed by confirmation via 10-fold cross-validation Results: There was no difference in richness or evenness between the ACVD and non-ACVD groups (alpha diversity; observed OTU index, p =0.503; Shannon’s index, p =0.478). However, significant differences were found in the overall salivary microbiota structure (beta diversity; unweighted UniFrac distances, p =0.001; weighted UniFrac distances, p =0.001). The Actinobacteria phylum was highly abundant in patients with ACVD, while the Bacteroidetes phylum was less abundant. The random forest classifier identified 43 OTUs as an optimal marker set of ACVD. In a 10-fold cross validation using the validation data, an area under the curve (AUC) of 0.933 (95% CI, 0.855–1.000) was obtained. Conclusions: The salivary microbiota in patients with ACVD was distinct from that of non-ACVD individuals, indicating that the salivary microbiota may be related to ACVD.     

新发高血压病人游离脂肪酸与动脉弹性变化

目的观察一个人群中新发高血压病人和未发生高血压者基线空腹血清游离脂肪酸(FFA)与2年内动脉弹性的变化的相关性,探索血清FFA、动脉弹性及高血压之间的关系。方法一纵向研究。社区筛选128例健康非高血压者(年龄33～60岁),随访2年。记录新发高血压例数,采用CVProfilorDO-2020型动脉弹性功能测定仪检测两组2年前后大、小动脉弹性指数(C1和C2),测定基线空腹血FFA、血脂、血糖、胰岛素等。随访期间,有12人失访。结果1)与未发生高血压者(n=97)相比,新发高血压病人(n=19)基线空腹血清饱和脂肪酸水平增高[(217±68)μmol/L比未发生高血压组:(186±46)μmol/L,P=0.04],而多不饱和与饱和脂肪酸比值(P/S)降低(1.60±0.37比未发生高血压组:1.90±0.46,P=0.009);2)与未发生高血压者相比,新发高血压者2年的收缩压和舒张压水平增高(P均<0.01),而其大、小动脉弹性指数改变值(ΔC1和ΔC2)有降低趋势(P均>0.05);3)逐步线性回归模型分析显示:全部参与者2年的ΔC1与基线空腹血清P/S正相关(标准回归系数0.201,P=0.041),独立于基线收缩压水平和经典的心血管危险因素。4)Logistic回归模型分析显示新发高血压者的基线空腹血清P/S的优势比(OR值)和95%可信区间为0.412(0.172～0.991,P=0.048)(在调整了经典的高血压危险因素后)。结论空腹血FFA组成异常是中青年非高血压人群大动脉弹性年龄相关改变和发生高血压的危险因素之一。     

Importance of MMP-8 in Salivary and Gingival Crevicular Fluids of Periodontitis Patients

Background: Matrix metalloproteinases (MMPs) stimulate alveolar bone loss in chronic periodontitis. Objective: To evaluate the salivary and gingival crevicular fluid (GCF) levels of MMP-8 in patients with moderate to severe chronic periodontitis. Methods: 42 participants were divided into two groups: a case group (21 patients with generalized moderate to severe chronic periodontitis) and a control group (21 healthy periodontal subjects). GCF and saliva samples were obtained from both groups. Salivary and GCF MMP-8 levels of each subject were detected using the ELISA method. Results: Mean±SD values of salivary MMP-8 levels of the control and case groups were 1.52 ± 0.65 ng/ml and 6.06 ± 1.18 ng/ml, respectively, and statistically significant difference was observed (p=0.0001). Also, mean±SD values of GCF MMP-8 levels of the control and case groups were 0.87 ± 0.26 ng/ml and 2.92 ± 0.64 ng/ml, respectively; which was statistically significant (p=0.0001). Conclusion: Our results demonstrate an increased concentration of salivary and GCF levels of MMP-8 in the patient group.     

The Excretion of Human Urinary Kallikrein Quantity and Activity in Normal and Low Renin Subgroups of Essential Hypertension

In both low and normal renin essential hypertensive groups, urinary excretion of kallikrein quantity by direct radioimmunoassay and activity by kininogenase assay were significantly lower than those in normal subjects. In comparing between normal and low renin groups, no difference was found in kallikrein quantity, while kallikrein activity tended to be lower in the low renin group than in the normal renin group. A significant positive correlation was observed between kallikrein quantity and activity in the normal subjects, the normal renin group and the low renin group. However, the slope of the regression line in the low renin group was significantly more moderate than that in the normal renin group, and tended to be more moderate than that in normal subjects. The addition of kallikrein inhibitors (aprotinin and gabexate mesilate) resulted in a significant suppression of enzymatic activity but not of enzyme quantity.

These findings suggest that suppression of the renal kallikrein system in both groups of essential hypertension was confirmed by the decreased excretion of kallikrein both as enzyme quantity and activity, and that in the mechanism of the suppression of urinary kallikrein activity in the low renin group, the renal kallikrein inhibitors may play some role.     

不同药物联合对男性高血压患者勃起功能的影响

目的探讨不同联合降压方案对高血压男性患者勃起功能的影响。方法采用前瞻性随机、平行、对照、固定治疗方案将148名≤60岁男性高血压患者随机分为3组:A组[非洛地平5 mg/d+厄贝沙坦150 mg/d(n=49)],B组[非洛地平5 mg/d+琥珀酸美托洛尔47.5 mg/d(n=46)],C组[非洛地平5 mg/d+氢氯噻嗪12.5 mg/d(n=53)]。治疗4周若血压≥140/90 mm Hg,非洛地平剂量加倍。随访6月。采用国际男性性功能判断指标(IIEF-5)分别于治疗前、后对IIEF-5和血清睾酮、性激素结合球蛋白(SHBG)进行评定。结果治疗后3组降压达标率、有效率组间比较均无统计学差异(均P>0.05)。治疗前、后勃起功能障碍(ED)的总发生率分别为34.46%、35.81%,差异无统计学意义(P>0.05)。3组治疗前后轻、中、重度ED的发生率之间亦无统计学差异。3组治疗前后中、重度ED的IIEF-5评分比较无统计学差异,但A组可提高轻、中度ED患者的IIEF-5评分。3组血清睾酮和SHBG治疗前后比较无统计学差异。结论非洛地平缓释片联合厄贝沙坦片有利于男性高血压轻、中度ED患者性功能的改善。     

高血压病患者颈动脉和股动脉管壁肥厚的早期判断及其临床意义

目的：旨在研究不同分期的高血压病患者在体颈动脉和股动脉的结构变化。方法：以正常组、高血压病Ⅰ期组、高血压病Ⅱ期组、非脑卒中型高血压病Ⅲ期组及高血压病伴脑卒中组为研究对象，采用超声心动图检测颈总动脉、颈内动脉和股动脉的内膜中层复合体厚度（ＩＭＴ）、管腔内径（Ｄ），并计算壁腔比值（ＩＭＴ／Ｄ）。结果：高血压病Ⅰ期组与正常组相比，３种动脉的ＩＭＴ及（或）Ｄ无显著性差异（颈内动脉的ＩＭＴ例外），而３种动脉的ＩＭＴ／Ｄ却均显著增大（Ｐ＜０．０１）；另３组患者，３种动脉除了ＩＭＴ／Ｄ增大外，ＩＭＴ和Ｄ逐渐增大，且随高血压分期而递增。结论：超声心动图检测技术为无创评估高血压病早期靶器官动脉损害的快速有效方法；颈动脉和股动脉结构变化可以作为了解高血压对动脉损害的“窗口”，用于指导分期和治疗，尤其是ＩＭＴ／Ｄ增大为高血压病早期动脉受损的灵敏指标。