Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation.

Dodson, P M; Beevers, M.; Hallworth, Richard; Webberley, M. J.; Fletcher, R. F.; Taylor, K. G.

doi:10.1136/bmj.298.6668.227

Cited by 101 publications

(50 citation statements)

References 12 publications

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“…However, there was still a large difference in baseline urinary sodium excretion between the HDS and the LDS groups (126 and 256 mmol/24 h, respectively). The mean increment in urinary sodium excretion with NaCl supplementation was 56 mmol/24 h, with oral NaCl supplementation of 100 mmol/24 h. In a previous study, supplementation with 80 mmol/24 h of a sustained release preparation of sodium increased urinary sodium excretion by 57 mmol/24 h [17]. The difference between intake and urinary excretion of sodium may be secondary to gastrointestinal side effects of the NaCl capsules or to net salt retention.…”

Section: Discussionmentioning

confidence: 99%

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Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

et al. 2010

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Aims/hypothesis We assessed the effects of sodium chloride (NaCl) supplementation on the blood pressure response to treatment with telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes and habitually high (HDS, sodium excretion >200 mmol/24 h on two out of three consecutive occasions) or low (LDS, sodium excretion <100 mmol/24 h on two out of three consecutive occasions) salt intake. Methods Patients received 4 weeks of telmisartan followed by 4 weeks of telmisartan plus hydrochlorothiazide. In a double-blind randomised fashion, patients received sodium chloride (NaCl, 100 mmol/24 h) or placebo capsules in addition to their habitual salt intake during the last 2 weeks of telmisartan and telmisartan plus hydrochlorothiazide therapy. The protocol was repeated with NaCl and placebo capsules administered in reverse order to allow each participant to act as his or her own control. At 0, 4, 8, 14, 18 and 22 weeks, 24 h ambulatory blood pressure (ABP) and 24 h urine collections were performed. Results No statistically significant differences were seen in the ABP response in the LDS vs HDS groups to any of the interventions (p=0.58). NaCl supplementation reduced the effect of telmisartan with or without hydrochlorothiazide on systolic BP by approximately 50% (−5.8 mmHg during NaCl supplementation vs −11.3 mmHg during placebo, mean difference 5.6 mmHg [95% CI 1.7-9.4 mmHg], p= 0.005), irrespective of habitual salt intake. By contrast, addition of hydrochlorothiazide increased the antihypertensive effect of telmisartan on systolic BP by approximately 35% (p=0.048) in both groups of patients. Conclusions/interpretation NaCl supplementation blunts the effectiveness of telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes, independently of habitual low or high salt intake.

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Section: Discussionmentioning

confidence: 99%

“…Early studies in the general population [14][15][16] and in patients with type 2 diabetes without nephropathy [17] have shown that salt restriction increases the efficacy of several antihypertensive drugs. Similar results have been reported in early and late renal disease.…”

Section: Discussionmentioning

confidence: 99%

Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

et al. 2010

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“…1), intervention should be considered. 35 In patients with mild hypertension, initial nonpharmacologic measures including dietary modification, exercise, restriction of alcohol, and weight loss should be attempted 36,37 ; in those who do not respond, or in patients with moderate to severe hypertension, pharmacologic therapy is indicated. Owing to a lack of evidence, controversy exists regarding the optimal target BP for patients with type II diabetes.…”

Section: Hypertensionmentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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“…48 A low-protein diet may therefore not be warranted, but it may be useful to introduce a low-sodium diet, especially if the patient does not respond to conventional therapy. 49,50 Cigarette smoking is also considered a risk factor and patients should be given advice regarding smoking cessation. 51 …”

Section: Microalbuminuria In Type 2 Diabetesmentioning

confidence: 99%

The reno-protective role of AT1-receptor blockers

2002

J Hum Hypertens

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In the 1970s and 1980s it became evident that progression of renal disease and blood pressure are correlated. Subsequently, it was shown that antihypertensive treatment, especially with agents that block the renin-angiotensin system (RAS), could slow the progression of diabetic renal disease. Several studies, particularly with RAS blockers, have confirmed beneficial effects on urinary albumin excretion in patients with diabetes and microalbuminuria or proteinuria. There are good reasons to explore dual blockade of the RAS with an AT 1 -receptor blocker and an ACE inhibitor. Receptor blockers may block the effects of angiotensin II more effectively than ACE inhibitors; moreover, ACE inhibitors increase bradykinins which may have positive effects on blood pressure and renal function. Such combination treatment has been found to be well tolerated and more effective in reducing blood pressure than either

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Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation.

Abstract: Objective-To determine the effect of moderate dietary sodium restriction on the hypertension of non-insulin-dependent (

Cited by 101 publications

References 12 publications

Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

The reno-protective role of AT1-receptor blockers

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