Beta blockade, diuretics, and salt restriction for the management of mild hypertension: a randomised double blind trial.

Abstract

benefit from hospital admission for selected patients with suspected myocardial infarction and where diagnostic or therapeutic help in the home was offered, home care did not make any substantial impact on the need for hospital services.If general practitioners do not consider home care to be an acceptable form of management for patients with suspected myocardial infarction, then there is little point in their playing any part when patients develop suspicious symptoms. In fact, general practitioners cannot help most patients who die from a heart attack: a register of all patients with heart attacks in the Nottingham Health District confirmed earlier reports that most deaths occur soon after the onset of symptoms and before medical aid is sought.7 8 If virtually all patients with heart attacks who survive long enough are going to be admitted to hospital, should the general practitioners and patients be persuaded that a call for an emergency ambulance is the appropriate action and not a call for a general practitioner? There is, however, little point in instituting such a programme of public education without an ambulance that can respond appropriately. After two of our earlier studies had shown that a single "coronary" ambulance could not be used effectively,9 10 the emergency and routine functions of our ambulance service were separated, and all the emergency vehicles are now being equipped with defibrillators and their crews specially trained. A programme of community education in the need to call for an emergency ambulance rather than a general practitioner together with public education in cardiopulmonary resuscitation is now beginning, and we shall use our heart attack register to monitor its effect. (51) mmol/24 h. Compared with the screening blood pressure the average decrement of the supine blood pressure in group 1 was 16-0/8-6 mm Hg with placebo, 21-7/11.5 mm Hg with the diuretic, 28-5/17-8 mm Hg with the J8 blocker, and 28 9/18-4 mm Hg with the combined agent; in group 2 these values were 13 3/6-1, 20 3/9-7, 21 3/12-9, and 29-4/16-8 mm Hg, respectively. There was a sharp decrease of the average potassium concentration during chlorthalidone and combination treatment periods (average value 3-3 mmol(mEq)/l).These results suggest that moderate salt restriction used as sole treatment has a limited though demonstrable blood pressure lowering effect but that when it is used as an adjuvant to 0i blocker treatment its value is greatly enhanced.

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

“…14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The median age was 50 years (ranging from 24 to 73 years). Of the 17 trials, 11 employed crossover design 14,18,20,21,24,[27][28][29][31][32][33] and six used paralleled comparisons.…”

“…Of the 17 trials, 11 employed crossover design 14,18,20,21,24,[27][28][29][31][32][33] and six used paralleled comparisons. 19,22,23,25,26,30 Nine out of the 17 trials were double-blind, 20,21,27-33 seven were blood pressure observer-blind, 14,19,[22][23][24][25][26] and one did not report any blinding procedure. 18 The study Figure 1 Summary of studies assessed and excluded through the stages of the meta-analysis.…”

“…18,19,[22][23][24][25][26] The number of trials using intention-to-treat analysis was small (seven out of 28 trials). 14,26,29,30,36,37 However, the percentage of subjects who were lost to follow-up after randomisation was small (6% on average).…”

“…In relation to salt, this can only be done by the use of salt tablets (Slow Sodium and placebo). Among the 28 trials included in our metaanalysis, 16 were double-blind, 20,21,[27][28][29][30][31][32][33][34][35][36][38][39][40] 11 were blood pressure observer-blind, 14,19,[22][23][24][25][26]37,41 and only one small trial in hypertensives was non-blind. 18 Reanalysing the data by excluding the non-blind study 18 showed that the results were unchanged.…”

Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials

“…RCT withdrawn, by outcome: n=0 RCT excluded, with reasons: -duration <2 weeks: n=54 -co-intervention(s): n=25 -duplicate publication: n=11 -conducted in patients or pregnant women: n=7 -non-placebo control group: n=5 -lack of (appropriate) BP data: n=3 Data on body weight (initial level and change) of the trial population could not be retrieved for 11 sodium trials (28%) 21,22,24,28,30,35,40,41,46,57,58 and 7 potassium trials (26%) 35,40,61,66,67,73,76 Data on body mass index were missing for 80% of the trials and could therefore not be taken into account in the analysis.…”