The Relationship Between Salt Threshold And Hypertension And TCM Syndromes

This paper contains three different parts including a literature review,a Meta-analysis and a clinical research.Part 1 Literature ReviewThe 1st review is mainly discussed that hypertension is the most common cardiovascular disease,the incidence of which is increasing,and the target organ damage caused by it has become the main cause of death.Salt is an important environmental factor in the pathogenesis of hypertension,which is closely related to the pathogenesis of hypertension.High salinity can cause blood pressure to rise through a variety of mechanisms,and accelerate the development of the target organ’s Nina,kidney and vascular damage.The 2rd review focuses on the understanding of hypertension and the relationship between salt or salty taste and the incidence of hypertension,from the point of view of medical etiology and pathogenesis,this paper expounds that salt or salty taste induced hypertension is closely related to liver,spleen,kidney and blood.The salt sensitivity of different TCM syndromes is different,and the sensitivity of salt in patients with hypertension is generally higher than that of deficiency syndrome.Clinical dialectical application of traditional Chinese medicine can improve blood pressure,target organ damage and symptoms in salt-sensitive hypertensive patients.Part 2 A Meta-analysis of random clinical trials mainly focus on the effects of dietary salt reduction on the blood pressure of patients diagnosed with essential hypertension in ChinaObjective:to explore the effect of reducing salt intake on blood pressure in hypertension patients in ChinaMethod:By searching databases like CNKI,Wanfang database,CBM,VIP,ChiCTR,Medline,Embase,Cochrane Library,Clinical Trials and Web of Science,materials intimately related to random clinical trials which mainly concern the effects of dietary salt reduction on the blood pressure of patients diagnosed with essential hypertension in China have been found out.Then they were selected under the guidance of the 5.1 version’ Cochrane HandBook’ and extracted to build a database which would greatly facilitate the quality assessment procedure.All the final materials were under a Meta-analysis by RevMan 5.3.Result:By searching every database listed before according to the included and excluded criteria with a time limitation from the set-up of the database to March,2018,9,072 materials were found and 11 were made the final ones.1,399 patients were involved.700 of them were from the experimental group while the left 699 were from the contrast team.①Meta-results showed that both the systolic blood pressure(SBP)and diastolic blood pressure(DBP)of Chinese hypertensive patients got a significant decline after salt intake reduction.The Weight Mean Difference(WMD)of combined SBP were-14.01 with a 95%Confidence Interval(CI)ranging from-19.93 to-8.09 and the Z value was 4.64,P value was less than 0.00001 while that of of combined DBP were-10.4,-16.73 to-4.07,3.22 and less than 0.001 accordingly.②Through a sensitivity analysis,only a smaller effect on the combined effect was found no matter which single study had been removed,implying that the differences between the included studies were smaller while the SBP and DBP estimates were from-21.04 to-5.98 and 18 to 1.5 separately.③Subgroup analysis based on duration of salt restriction found that SBP,DBP decreased significantly among the intervention time less than one month group,intervention time is more than one month but less than 3 months group and intervention time is more than 3 months group.SBP combined WMD of each group was-20.2 with a 95%CI from-26.2 to-13.85.Z value was 6.36 while P value was less than 0.00001 and i2 was 91%,-6.41 with a 95%CI from-10.82 to-2.01.Z value was 2.85 while P value was less than 0.004 and i2 was 82%,-7.39 with a 95%CI from-11.97 to-2.882.Z was 3.17 while P value was 0.002 and i2 was 82%.DBP combined WMD of each group was-15.68 with a 95%CI from-22.61 to-8.75.Z value was 4.43 while P value was 0.00001 and i2 was 99%,-9.00 with a 95%CI from-16.22 to-1.77.Z value was 2.44 while P value was 0.01 and i2 was 97%],-3.03 with a 95%CI from-6.2 to-0.19.Z value was 1.85 while P value was 0.06 and i2 was 78%.Conclusion:① Salt reduction led to the decline of both SBP and DBP;②It was found that effects of salt reduction were somehow related to its duration.Part 3 Clinical ResearchObjective:1.to explore the relationship among salt threshold,salt intake,hypertension and target organ damage;2.to explore the correlation between salt threshold and the TCM syndromes of hypertensive patients.Method:Basic information,dietary habit,haematological indexes,Urine indexes and examine results of target organ damage were collected from the included 100 patients.Haematological indexes contained fasting blood glucose,blood lipids,inslin,uric acid,blood urine nitrogen,serum creatinine,homocysteine,electrolytes,etc.Urine indexes included 24-hour urine Sodium,24-hour urine protein,micro albumin,retinol-binding protein,N-Acetyl phenolphthalein glucoside,β2-micro-globulin,uterine creatinine,UNa/Cr,mAlb/UCr and NAG/UCr.Target organ damage examine were as follow:vascular endothelial function examination,examination of limb arteries,24-hour Holter,ultrasonic examination of carotid artery and echocardiographic examination.Meanwhile,questionnaire was made to interview symptoms and gather their tongue and pulse imaging to give a final syndrome differentiation.Patients were divided into A and B group according to salt threshold,a relation was aimed to be unveiled among salt threshold,salt intake,hypertension and TCM syndrome types.Result:1.Patients with hypertension were compared with the normal control group.1.1 comparison of baseline:the comparison of age,sex,height,weight and BMI between the hypertension group and the normal group,and the statistical analysis,P>0.05,suggesting that there is no statistical difference between the two groups,which is comparable.1.2 24h sodium,salt intake,blood pressure(SBP,DBP)and salt threshold comparison:hypertension group and normal control group 24h 尿钠,daily salt intake and blood pressure(SBP,DBP)compared,P<0.05,the results were statistically different,hypertension group salt intake,24h urine sodium,SBP,DBP levels were significantly higher than normal.Salt intake of men was higher than women.There was no significant difference in the salt threshold between the hypertension group and the normal control group(P>0.05).2.Salt intake and hypertension-related factors:2.1 Family history:according to the family history of hypertension,100 cases of hypertension were divided into 2 groups,P>0.05,and the two groups of salt intake were compared,the results were not statistically significant.2.2 Salty flavors were brackish:the salt intake was compared with the salty flavor group and not salty taste group,P<0.001,the results were statistically different,and the salt intake in the salty flavor group was significantly higher than that in the non-salty group.2.3 Hypertension classification and salt intake comparison:P>0.05,there was no significant difference between the two groups.From the overall data,the trend of salt intake is:2 grade hypertension>3 grade hypertension>1 level hypertension.2.4 The risk factors of hypertension were compared with salt intake:P<0.05,the results were statistically significant,and very high risk group>middle risk group>high risk group.3.The correlation between salt threshold and salt intake,24h sodium and blood pressure:The salt intake and 24h urinary sodium SBP in group A and group B were all less than 0.05,and the difference was statistically significant.Patients in group B had higher levels of 24h,urinary sodium,salt intake and SBP than those in group A.The correlation analysis showed that the correlation between salt threshold and 24h urine sodium UNa,daily salt intake and SBP was significant(bilateral test,confidence level of 0.01)and positive correlation(the correlation coefficient was 0.393,0.393,0.718,respectively).After comparison,the DBP group was P>0.05,and the result was not statistically significant.4.Salt threshold height and hypertension and related factors were compared.They were divided into A group and B group according to salt threshold.4.1 Compared with group A and group B,the age,height,weight,waist.circumference,sex,course of disease,smoking history,drinking history,type of work,exercise,BMI,sodium,blood potassium,blood chlorine,HCY,TC,TG,HDL-C,LDL-C,VLDL-C,P>0.05,there was no statistical difference between A and B two groups.The situation is basically the same,with comparability.4.2 Family history:A group compared with group B,P>0.05,suggesting no significant difference between two groups.4.3 Taste is salty:A group and B group in the salty taste,P<0.05,suggesting significant statistical difference,A group tastes heavier than B group.Two-element Logistic regression analysis was carried out with salt threshold and salty taste as independent variable.The results were B=2.773,SE=0.777,Wals=12.724,P=0.000<0.001,suggesting that the salty taste was positively correlated with salt threshold.4.4 Hypertension classification:the difference of salt threshold 22 between different hypertensive patients was P,all<0.05,the results were statistically significant.From the overall scale,the proportion of patients in group A is higher than that in group B,which indicates that the higher the blood pressure level is,the higher the salt threshold is.4.5 Risk stratification of hypertension:P in group A and group B were all above 0.05,and no significant difference was found.On a whole,the proportion of A group in each stratification group is obviously higher than that in B group.5.Comparison of salt threshold and target organ damage index5.1 Comparison of vascular damage index:A,B two groups of FMD,bilateral ABI and baPWV,IMT,P>0.05,the results were not statistically significant.From the overall data,the baPWV and IMT of the two groups were significantly higher than those of the normal upper limit.5.2 FBG,INS Oh,HbAlc and insulin sensitivity index:A,B two groups of FBG,INS Oh,HbAlc and insulin sensitivity index comparison,P>0.05,there is no statistical difference.From the overall data,the FBG of the two groups were significantly higher than the normal upper limit,and the insulin sensitivity index of A group was higher than that of B group while HbA1c was lower.5.3 Comparison of renal damage indexes:the comparison of BUN,UA,Scr,mAlb,RBP,NAG,2-MG,mAlb/Cr,NAG/Cr,24h proteinuria in the two groups of A and two groups was more than 0.05,and there was no statistical difference.The early detection rate of renal damage in group A was 19.2%,group B was 13.6%,and group A was slightly higher than that in group B,but P>0.05,there was no statistical difference.5.4 Comparison of the index of heart damage:the comparison of SV1,RV5,SV1+RV5 and 24h in group A and B,HR,SDNN,LVEDD,LA,EF,all P were>0.05,and there was no statistical difference.From the overall data,the mean values of HR,SDNN,LVEDD;LA and EF of SV1,RV5,SV1+RV5 and 24h in the two groups were all within the normal range.6.The TCM syndrome types of hypertension patients were compared with salt threshold and salt intake.6.1 The distribution of the TCM syndrome types:100 cases selected patients,liver fire hyperactivity type were 34 cases,yin deficiency and yang hyperactivity were 24 cases and 22 cases of Phlegm Dampness Retention,11 cases of Yin Yang deficiency,9 cases of blood stasis type.6.2 Relationship between the general and TCM Syndrome Types:in addition to the more anger hyperactivity group and phlegm dampness group waist,P<0.05,with statistical difference,the age,BMI and waist circumference of other groups were compared,and P was>0.05.There was no statistical difference between the other groups,except for the group of yin deficiency yang hyperactivity and the group of phlegm dampness and blood stasis,P<0.05,and the other groups had no statistical difference in sex.6.3 The relationship between salt threshold and salt intake and TCM syndrome types:6.3.1 Comparison of salt intake among different syndrome patients:the salt intake of patients with different syndromes of hypertension was compared with each other,P>0.05,there was no statistical difference.On a whole,the trend of salt intake is Phlegm Dampness Retention type>hyperactivity of liver fire type>Yin Yang two deficiency type>Yin deficiency yang hyperactivity type>blood stasis type.6.3.2 Different salt threshold group of hypertension patients and salt intake comparison:A,B group liver fire hyperactivity and yin deficiency Yang Hyperactivity of HT patients salt intake,P<0.05,there are statistical differences between groups,other syndrome types in the A,B two groups did not find statistical differences.In group A,the salt intake of yin deficiency yang hyperactivity type patients was significantly different from those of patients with phlegm dampness type and blood stasis type,P<0.05.From the overall trend,the amount of salt intake in the patients with phlegm dampness type in A group was the highest,followed by Yin Yang two deficiency type,liver fire hyperactivity type,yin deficiency and yang hyperactivity type,and the lowest blood stasis type.In the B group,the salt intake was the highest in the patients with Yin deficiency and yang hyperactivity,followed by the Yin and yang two deficiency type and the liver fire hyperactivity type,the phlegm dampness was the secondary,and the lowest was the blood stasis type.Conlusion:1.The prevalence of salt in HT patients was higher than that of normal people,and males took more salt than females.2.The salt threshold was correlated with 24h urine sodium,salt intake,SBP and taste with a positive correlation.3.Salt intake were consistent with the salt threshold in HT patients.4.There was no significant difference in salt intake in patients with different levels of hypertension,but there were significant differences in salt intake in hypertensive patients in different risk groups.The highest level of salt intake was in the extremely high-risk group.5.BAPWV,IMT and Glu were higher in HT patients,and the insulin sensitivity index of the salt threshold was lower than that of the lower salt threshold.6.In the low salt threshold group,phlegm-dampness HT patients were found with the most salt intake while Yin deficiency hyperactivity HT patients were with the highest salt intake in the high salt threshold group,which suggested that we should pay more attention to salt-limited diet.