1. Choice of Antihypertensive Combination Therapy Based on Daily Salt Intake
- Author
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Shu Inami, Toru Kato, Shigeru Toyoda, Kinji Tsukada, Yukitaka Anraku, Akihiro Suzuki, Yoshinobu Kikegawa, Teruo Inoue, Koichi Node, and Akiya Nakamoto
- Subjects
Male ,medicine.medical_specialty ,Combination therapy ,Urology ,Tetrazoles ,Blood Pressure ,Pharmacology ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,Heart Rate ,law ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,Amlodipine ,Sodium Chloride, Dietary ,Salt intake ,Diuretics ,Antihypertensive Agents ,Thiazide ,Aged ,Metabolic Syndrome ,Creatinine ,business.industry ,Sodium ,Valine ,General Medicine ,Middle Aged ,Amlodipine, Valsartan Drug Combination ,Drug Combinations ,Hydrochlorothiazide ,Treatment Outcome ,Blood pressure ,Valsartan ,chemistry ,Hypertension ,Potassium ,Female ,business ,medicine.drug - Abstract
It is unclear whether thiazide diuretics (TZs) or calcium channel blockers (CCBs) are more effective as add-on therapy to angiotensin receptor blockers (ARBs) in controlling hypertension. Because TZs are a rational choice in salt-sensitive hypertension, patients with high salt intake might preferentially benefit from ARB/TZ over ARB/CCB combination therapy.Hypertensive patients who failed to reach blood pressure goals despite treatment with ARBs alone were randomly assigned to receive either ARB/TZ or ARB/CCB combination therapy. Estimated daily sodium intake was calculated from spot urine values of sodium and creatinine.Blood pressure was measured at baseline, and at 4, 8 and 12 weeks after starting combination therapy. For all study patients (n = 87), diastolic blood pressure reduction was greater in patients receiving ARB/CCB treatment. However, in the 37 patients with a baseline estimated daily salt intake greater than 10 g and baseline systolic blood pressure (SBP) ranging from 150 to 200 mm Hg, SBP was lower (P0.05) and SBP reduction was greater (P0.05) 4 weeks after starting combination therapy in those receiving ARB/TZ treatment. In the 31 patients whose estimated daily salt intake increased at 12 weeks compared with baseline, SBP at 12 weeks was lower in those receiving ARB/TZ treatment (P0.05).Estimated daily salt intake is a useful tool for guiding antihypertensive therapy and should be measured repeatedly during the therapeutic course.
- Published
- 2015