Summary
Interpopulation studies support the hypothesis of a causal relationship between sodium consumption and arterial hypertension. However, although this association has been contradicted by intrapopulation studies, the correlation between sodium and hypertension appears to be genetically determined, as there are both sodium-sensitive and sodium-resistant individuals.
Sodium is essential for the maintenance of extracellular and plasma volume equilibrium. It is controlled metabolically by the interaction of several biological systems such as the renin-angiotensin-aldosterone system, the sympathetic nervous system, and the kallikrein-kinin and prostaglandin systems. Thus, sodium has a definite role in the mechanism involved in the pathophysiology of the predominantly volume-dependent forms of arterial hypertension.
Recently, different structural substances with natriuretic effects have been identified. Natriuretic hormone is a non-peptide substance which inhibits the Na,K-ATPase in response to extracellular volume increase. This hormone acts on the renal tubular cells reducing sodium reabsorption, and at an arteriolar level elevating peripheral resistance by increasing smooth muscle tension. Mammalian atria contain various precursors of biologically active peptides, with potent natriuretic and diuretic effects. They are released in response to volume loading and atrial stretch. Although some data suggest an important role for these natriuretic substances in fluid volume and blood pressure control, their place in physiology and in abnormal clinical states should be more definitively clarified in the next few years.
Résumé
Les études interpopulations renforcent l’hypothèse d’une relation causale entre la consommation de sodium et l’hypertension artérielle. Cette corrélation est contredite par les études intrapopulations, elle semble toutefois génétiquement déterminée puis qu’il existe à la fois des individus sodium-sensibles et des individus sodium-résistants.
Le sodium est essentiel au maintien de l’équilibre des volumes extracellulaire et plasmatique. Il est métaboliquement contrôlé par l’interaction de plusiers systèmes biologiques tels que le système aldostérone-rénine-angiotensine, le système nerveux autonome, les systèmes prostaglandines et kallikréine-kinines. Ainsi, le sodium joue un rôle précis dans le mécanisme qui intervient dans la physiopathologie des hypertensions artérielles essentiellement volume-dépendantes.
Récemment, on a identifié différentes substances natriurétiques. L’hormone natriurétique est une substance non peptidique qui inhibe la Na, K-A TPase en réponse à une augmentation du volume extracellulaire. Cette hormone agit sur les cellules tubulaires rénales provoquant une diminution de la réabsorption du sodium et au niveau artériolaire, élevant les résistances périphériques par augmentation de la contraction des muscles lisses. L’oreillette des mammifères contient divers précurseurs des peptides biologiquement actifs, qui majorent les effets natriurétique et diurétique. Ils sont libérés en réponse à un accroissement des volumes et à une distension auriculaires. Un certain nombre de données suggère que ces substances natriurétiques tiennent un rôle important dans le contrôle des volumes liquidiens et de la pression sanguine. Cependant, leur rôle exact dans la physiologie et les états cliniques pathologiques devraient être plus clairement précisé dans les prochaines années.
Zusammenfassung
Bevölkerungsstudien stützen die Hypothese einer kausalen Beziehung zwischen Natriumverbrauch und arterieller Hypertonie. Wenn auch dieser Assoziation in Bevölkerungsstudien widersprochen wurde, scheint jedoch die Korrelation zwischen Natrium und Hypertonie genetisch bestimmt zu sein, da es sowohl Natrium-sensitive als auch Natrium-resistente Personen gibt.
Natrium ist für die Aufrechterhaltung des Gleichgewichts von extrazellulärem und Plasma-Volumen erforderlich. Es wird metabolisch durch die Interaktion verschiedener biologischer Systeme, wie das Renin-Angiotensin-Aldosteron-System, das sympathische Nervensystem sowie das Kalikrein-Kinin und das Prostaglandin-System kontrolliert. Damit besitzt das Natrium eine definitive Rolle bei dem Mechanismus, der an der Pathophysiologie der vornehmlich Volumenabhängigen Formen der arteriellen Hypertonie beteiligt ist.
Kürzlich wurden verschiedene strukturelle Substanzen mit natriuretischen Effekten identifiziert. Das natriuretische Hormon ist eine nicht peptidartige Substanz, die die Na, K-A TPase in Reaktion auf einen Anstieg des extrazellulären Volumens hemmt. Dies Hormon wirkt auf die Zellen der Nierentubuli, indem es die Natriumresorption reduziert und auf Höhe der Arteriolen den peripheren Widerstand durch Erhöhung des Tonus der glatten Muskulatur erhöht. Der Herzvorhof von Säugetieren enthält verschiedene Vorstufen von biologisch-aktiven Peptiden mit potenten natriuretischen und diuretischen Effekten. Sie werden als Reaktion auf eine Volumenüberladung und Dehnung des Vorhofs freigesetzt. Wenn auch einige Daten eine wichtige Rolle für diese natriuretische Substanzen bei der Kontrolle des Flüssigkeitsvolumens und Blutdrucks vermuten lassen, sollte ihre Bedeutung in der Physiologie und abnormen klinischen Zuständen in den nächsten paar Jahren definitiv geklärt werden.
Resumen
Los estudios interpoblación confirman la relación causal entre consumo de sodio e hipertensión arterial. Aunque esta asociación ha sido negada por otros estudios intrapoblación, la cor-relación entre sodio e hipertensión parece estar determinada genéticamente al haber individuos sodiosensibles y sodiorresistentes.
El sodio es esencial para el mantenimiento del equilibrio del volumen extracelular y el plasmatico, controlado metabólicamente por la interaccion de varios sistemas biológicos, tales como el de renina-angiotensina-aldosterona, el sistema nervioso simpâtico y los sistemas calicreína-cinina y prostaglandina. Así pues, el sodio desempeña una función bien definida en el mecanismo fisiopatológico de las formas de hipertensión arterial, en su mayor parte dependientes del volumen.
Recientemente se han identificado diferentes sustancias estructurales con efectos natriuréticos. La hormona natriurética es una sustancia no peptídica que inhibe la Na, K-A TPasa en respuesta al aumento de volumen extracelular. Esta hormona actúa sobre las células tubulares rénales reduciendo la reabsorción de sodio y elevando la resistencia periférica en las asteriolas por aumento de la tension del músculo liso. Las aurículas de mamífero contienen diversos precursores de péptidos biológicamente activos con potentes efectos natriuréticos y diuréticos, que se liberan en respuesta a la carga de volumen y a la dilatación auricular. Aunque algunos datos parecen confirmar la importancia de estas sustancias natriuréticas en el control del volumen líquido y de la presión arterial, su función en fisiología y en los estados clínicos anómalos debera determinarse con mayor precisión en el futuro.
Resumo
Estudos interpopulacionais sustentam a hipótese de que o consumo de sódio tem relação causal com a hipertensão arterial. Entretanto, embora os estudos intrapopulacionais tenham contradito uma tal associação, a correlação entre o sódio e hipertensão parece ser genéticamente determinada, uma vez que há indivíduos sensíveis e indivíduos resistentes ao sódio.
O sódio é essencial para a manutenção do equiliíbrio do volume plasmático e extracelular. Ele é controlado metabolicamente pela interação de diversos sistemas biológicos, tais como o sistema renina-angiotensina-aldosterona, o sistema nervoso simpático e os sistemas calicreínaquinina e prostaglandina. Assim sendo, o sódio tem papel definido no mecanismo implicado na fisiopatologia das formas de hipertensão arterial predominantemente dependentes do volume.
Recentemente, identificou-se diversas substâncias estruturais com efeitos natriuréticos. O hormônio natriurético é uma substância não-peptídica que inibe a Na-K-A TPase como reação a um aumento do volume extracelular. Este hormônio a tua nas células tubulares renais, reduzindo a reabsorção do sódio, e, num nível arteriolar, elevando a resistência periférica por meio de um aumento da tensão de músculo liso. Os átrios de mamíferos contêm diversos precursores de peptídeos biologicamente ativos, dotados de poderosos efeitos natriuréticos e diuréticos. Eles são liberados em reação ao aumento do volume e ao estiramento dos átrios. Embora alguns dados surgiram que estas substâncias natriuréticas tenham um papel importante no controle do volume de fluido e da pressão sanguínea, o seu desempenho nafisiologia e nos estados clínicos anormals deveria ser esclarecido de forma mais definida nos próximos anos.
Riassunto
Gli studi tra popolazioni confermano l’ipotesi di un rapporto causale ira consumo di sodio e ipertensione arteriosa. Tuttavia, sebbene questo rapporto sia stato smentito da studi intrapopolazione, la correlazione tra sodio e ipertensione appare geneticamente determinata, poichè vi sono sia individui sodio—sensibili che sodio-resistenti. Il sodio è essenziale per il mantenimento dell’equilibrio del volume plasmatico ed extracellulare. È controllato metabolicamente dall’inter azione di diversi sistemi biologici, come il sistema renina—angiotensina—aldosterone, il sistema nervoso simpatico e i sistemi callicreina—chinina e prostaglandinico. Pertanto il sodio ha un ruolo preciso nei meccanismi fisiopatologici delle forme di ipertensione arteriosa di tipo prevalentemente volume—dipendente. Recentemente sono state identificate differenti sostanze con effetti natriuretici. Vormone natriuretico è una sostanza non peptidica che inibisce la Na, K—ATPasi in risposta ad aumenti del volume extracellulare. Questo ormone agisce sulle cellule dei tubuli renali riducendo il riassorbimento di sodio e a livello arteriolare aumentando la tensione della muscolatura liscia. Gli atri dei mammiferi contengono vari precursori di peptidi biologicamente attivi, con potenti effetti natriuretici e diuretici. Queste sostanze vengono liberate in risposta ad aumenti di volume o a distensione atriale. Sebbene alcuni dati suggeriscano l’importanza di queste sostanze natriuretiche nel controllo dei volumi e della pressione arteriosa, il loro ruolo e in condizioni fisiologiche e patologiche dovrebbe essere meglio chiarito nei prossimi anni.
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Francischetti, E.A., Genelhu, V. & Oigman, W. Sodium and Hypertension Still a Controversy in 1986. Drugs 31 (Suppl 4), 29–39 (1986). https://doi.org/10.2165/00003495-198600314-00005
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DOI: https://doi.org/10.2165/00003495-198600314-00005