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盐摄入、限盐和原发性(特发性)高血压

Author
Norman M Kaplan, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc
Translators
任川, 主治医师

引言

钠的摄入和血压(blood pressure, BP)的关系以及限钠对无并发症的原发性高血压患者的作用将在本专题讨论。对于伴有急性或慢性肾脏病的高血压患者，限制钠摄入和采用利尿剂清除液体在治疗中发挥着更加关键的作用。 (参见“急性和慢性肾脏病中高血压的概述”，关于‘限钠的益处’一节)

其他因素与发生高血压之间的关系，高血压患者的评估和一般及特定亚组人群的高血压治疗将在别处讨论。(见相关专题。)

钠的摄入和高血压

原发性高血压主要见于钠平均摄入量大于100mEq/d(2.3g Na)的人群；而在钠平均摄入量小于50mEq/d(1.2g Na)的人群中很少见[1,2]。这些观察结果提示高血压的发生需要达到钠摄入阈值。这种效应似乎独立于高血压的其他危险因素，如肥胖。

除了钠，氯(盐里的伴随阴离子)在原发性高血压的发病机制里似乎也起着重要作用[3]。钠敏感患者中氯化钠摄入量增加会使血容量增加和血压升高；但是如果给予钠和其他阴离子[比如枸橼酸盐(可被代谢为碳酸氢盐)]或者氯和其他阳离子(比如铵离子)则不会出现上述现象[3]。

将盐的摄入量从170mEq/d降至100mEq/d时，血压正常成人的平均血压会降低约2/1mmHg，而高血压成人的平均血压会降低5/3mmHg[4]。但血压可能在30年中出现更大降低，部分原因是限盐可以最大程度地降低年龄增长导致的血压正常增高[2]。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-20.
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