|
Item #8.
A Low-Sodium Diet Potentiates
the Effects of Losartan in Type 2 Diabetes
A low-sodium diet potentates the antihypertensive and
antiproteinuric effects of losartan in type 2 diabetes
Diabetic
subjects have a high prevalence of hypertension,
increased total body exchangeable sodium levels, and an
impaired ability to excrete a sodium load. This study
assessed the effect of dietary sodium restriction on the efficacy
of losartan in hypertensive subjects with type 2 diabetes
and albumin excretion rates of 10–200 µg/min.
In this
study, 20 subjects were randomized to losartan 50
mg/day (n = 10) or placebo (n = 10). Drug
therapy was given in two 4-week phases separated by a
washout period. In the last 2 weeks of each phase, patients
were assigned to low- or regular-sodium diets, in random
order. In each phase, 24-h ambulatory blood pressure,
urinary albumin-to-creatinine ratio (ACR), and renal
hemodynamics were measured.
RESULTS—Achieved
urinary sodium on a low-sodium diet was 85 ± 14 and 80
± 22 mmol/day in the losartan and placebo groups,
respectively. In the losartan group, the additional
blood pressure-lowering effects of a low-sodium diet compared
with a regular-sodium diet for 24-h systolic, diastolic, and
mean arterial blood pressures were 9.7 mmHg (95% confidence
interval [CI], 2.2-17.2; P = 0.002), 5.5 mmHg
(2.6-8.4; P = 0.002), and 7.3 mmHg (3.3- 11.3;
P = 0.003), respectively. In the losartan group,
the ACR decreased significantly on a low-sodium diet
versus on a regular-sodium diet (-29% [CI -50.0 to -8.5%]
vs. + 14% [-19.4 to 47.9%], respectively; P = 0.02).
There was a strong correlation between fall in blood
pressure and percent reduction in the ACR (r =
0.7, P = 0.02). In the placebo group, there were
no significant changes in blood pressure or ACR between
regular- and low-sodium diets. There were no significant changes
in renal hemodynamics in either group.
CONCLUSIONS—These
data demonstrated that a low-sodium diet potentiates
the antihypertensive and antiproteinuric effects of
losartan in type 2 diabetes. The blood pressure reduction
resulting from the addition of a low-sodium diet to losartan
was of similar magnitude to that predicted from the addition
of a second antihypertensive agent.
Diabetes Care
25:663-671, 2002
================================
Did You Know:
People with
type 2 diabetes have the same risk of heart attack as people
without diabetes who have already had a heart attack.
Back / Next Item
[an error occurred while processing this directive]
|
