Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study.

MacGregor, G. A.; Markandu, Nirmala D.; Singer, Donald R. J.; Cappuccio, Francesco P.; Shore, AC; Sagnella, Giuseppe A.

doi:10.1136/bmj.294.6571.531

Cited by 84 publications

(35 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This increase in angiotensin II can be blocked by the addition of an inhibitor of the reninangiotensin-aldosterone system 18 so that blood pressure then becomes much more dependent on sodium and water balance. This concept was supported by two previous studies in which it was found that in patients with essential hypertension in whom the renin system is blocked by captopril 6 or enalapril, 7 moderate sodium restriction results in a further fall in blood pressure. Furthermore, with sodium restriction alone, there is no relation between changes in sodium balance and the degree to which blood pressure falls, 1 -3 whereas when the renin system is blocked, the change in blood pressure is significantly correlated with the change in dietary sodium intake.…”

Section: Discussionmentioning

confidence: 55%

“…Furthermore, with sodium restriction alone, there is no relation between changes in sodium balance and the degree to which blood pressure falls, 1 -3 whereas when the renin system is blocked, the change in blood pressure is significantly correlated with the change in dietary sodium intake. 6 Treatment with angiotensin converting enzyme inhibitors alone does not always control blood pressure in patients with moderate-to-severe essential hypertension. The addition of a thiazide diuretic to angiotensin converting enzyme inhibitor treatment has been shown to be effective in reducing blood pressure to the desired range in many patients with more severe essential hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…8 - 10 This further fall in blood pressure with the addition of a thiazide 8 -10 appears to be similar to the fall in blood pressure with the addition of sodium restriction to a converting enzyme inhibitor. 6 ' 7 However, blood pressure is not always controlled with this combination of a converting enzyme inhibitor and a thiazide. Increasing the dose of diuretic will cause a further fall in blood pressure but is associated with greater adverse metabolic effects even in the presence of a converting enzyme inhibitor.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Sodium restriction in hypertensive patients treated with a converting enzyme inhibitor and a thiazide.

et al. 1991

Self Cite

View full text Add to dashboard Cite

When the function of the renin system is inhibited, blood pressure becomes more dependent on changes in sodium and water balance. Diuretics alone and sodium restriction alone are additive to converting enzyme inhibitor therapy. However, it is not known if these two ways of reducing sodium balance are additive in the presence of established converting enzyme inhibition. We therefore performed a double-blind crossover study of the effects of moderate sodium restriction in 21 patients with essential hypertension who were already being treated with the combination of a converting enzyme inhibitor and a diuretic. After 1 month of captopril (50 mg twice daily) and hydrochlorothiazide (25 mg once daily) therapy, with their usual sodium intake, average supine blood pressure was 147/96 ± 5/3 (SEM) mm Hg 2 hours after treatment Patients then reduced their sodium intake to around 80-100 mmol/day for the remainder of the study. After 2 weeks of sodium restriction, they entered a double-blind, randomized, crossover study of Slow Sodium (100 mmol sodium/day) compared with Slow Sodium placebo, while continuing sodium restriction and the above treatment. During the double-blind study, after 1 month of treatment with captopril (50 mg twice daily), hydrochlorothiazide (25 mg once daily), and Slow Sodium placebo, supine blood pressure 2 hours after treatment was 138/88 ±4/2 mm Hg (24-hour urinary sodium 1 0 4 ± l l mmol). After 1 month of captopril (50 mg twice daily), hydrochlorothiazide (25 mg once daily), and Slow Sodium tablets, supine blood pressure 2 hours after treatment was 147/91 ±5/2 mm Hg (p<0.05; 24-hour urinary sodium 195 ±14 mmol). Mean supine blood pressure fell with moderate sodium restriction by 5±2% at 2 hours and 7 ±2% at 12 hours after treatment with captopril and hydrochlorothiazide. The decrease in blood pressure was significantly correlated with the reduction in sodium intake. These results clearly demonstrate that a moderate reduction in salt intake does have a further blood pressure-lowering effect in patients already treated with the combination of captopril and a diuretic. This moderate change in diet provides an effective and well-tolerated way to improve blood pressure control in patients treated with the combination of an angiotensin converting enzyme inhibitor and a diuretic (Hypertension 1991;17:798-803) M oderate restriction of salt intake is known to lower blood pressure in many patients with essential hypertension.1 -2 However, the extent of the fall in blood pressure in an individual patient appears to depend inversely on the reactive rise in renin release, and thereby angiotensin II, as sodium is lost from the body. Received February 26, 1990; accepted in revised form September 27, 1990. have also been reported with diuretics. 5 However, once the function of the renin system is inhibited, such as occurs with converting enzyme inhibitors, both salt restriction alone 67 and diuretics alone 8 " 10 cause a further fall in blood pressure that is dependent on the amount of sodium loss. However, no...

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sodium restriction in hypertensive patients treated with a converting enzyme inhibitor and a thiazide.

et al. 1991

Self Cite

View full text Add to dashboard Cite

show abstract

“…4,24 Evidence suggests that lowering salt intake will be of benefit in CKD, reducing proteinuria and urinary albumin excretion, as well as enhancing the antiproteinuric and antihypertensive effects of blockers of the renin-angiotensin system. 25,26 A recent review of interventional studies in CKD concluded that there was evidence that salt reduction lowered blood pressure in patients with CKD, but acknowledged that there was an overall lack of studies in this patient group.…”

Section: Salt and The Kidneymentioning

confidence: 99%

The health impacts of dietary sodium and a low-salt diet

Suckling

Swift

2015

Clinical Medicine

View full text Add to dashboard Cite

High salt intake is now endemic worldwide. It contributes to the generation and maintenance of high blood pressure, which is now the biggest risk factor for global disease. There is now compelling evidence to support salt reduction in hypertensives and a substantial body of evidence to support salt reduction in the general population to reduce risk of death from cardiovascular disease. In specific diseases such as heart failure and chronic kidney disease, guidelines support the World Health Organization target for reduced salt intake at 5 g daily. Achieving a diet that is lower in salt has challenges, but is more likely to be achieved through salt reduction strategies particularly focused on processed food and through educational programs. To be effective, these interventions require collaboration between industry, health agencies and governments.

show abstract

“…The study demonstrated an approximate 9% fall in blood pressure with moderate salt restriction when on captopril and this fall in blood pressure was significantly related to the reduction in urinary sodium excretion but not the severity of the blood pressure. Overall the study suggested that the combination of an angiotensin-enzyme inhibitor with a moderate but practical reduction in salt intake could be very effective in controlling blood pressure in many patients with essential hypertension (MacGregor et al, 1987). I…”

Section: Introductionmentioning

confidence: 99%

The importance of the response of the renin‐angiotensin system in determining blood pressure changes with sodium restriction.

Macgregor

1987

Brit J Clinical Pharma

View full text Add to dashboard Cite

There is controversy about the efficacy of sodium restriction in the treatment of hypertension. Short‐term restriction of sodium intake in normotensive subjects causes little or no fall in blood pressure. This lack of response of blood pressure to sodium restriction appears to be due, at least in part, to a reactive rise in renin and angiotensin II. In patients with essential hypertension there is suppression of the renin‐angiotensin system particularly as blood pressure becomes more severe. With sodium restriction there is less of a rise in renin and angiotensin II compared with normotensive subjects and patients have a greater fall in blood pressure compared with normotensive subjects but the effect is less in mild compared to severe hypertension. As the formation of angiotensin II can now be blocked by the use of a converting enzyme inhibitor, the combination of moderate salt restriction in conjunction with a converting enzyme inhibitor is likely to be more effective in lowering blood pressure than either treatment on its own.

show abstract

Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study.

Cited by 84 publications

References 17 publications

Sodium restriction in hypertensive patients treated with a converting enzyme inhibitor and a thiazide.

Sodium restriction in hypertensive patients treated with a converting enzyme inhibitor and a thiazide.

The health impacts of dietary sodium and a low-salt diet

The importance of the response of the renin‐angiotensin system in determining blood pressure changes with sodium restriction.

Contact Info

Product

Resources

About