Document Detail


Effects of dietary sodium on blood pressure in IDDM patients with nephropathy.
MedLine Citation:
PMID:  8635674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objectives of the study were to assess the effects of moderate sodium restriction on blood pressure in insulin-dependent diabetic (IDDM) patients with nephropathy and high normal or mildly hypertensive blood pressure (primary objective), and to document possible associated changes of exchangeable body sodium, body volumes, components of the renin-angiotensin-aldosterone system, atrial natriuretic peptide, and catecholamines (secondary objective). Sixteen patients with untreated systolic blood pressure > or = 140 < 160 mmHg and/or diastolic blood pressure > or = 85 < 100 mmHg were included in a double-blind, randomized, placebo-controlled trial. After a 4-week run-in period on their usual diet and a 2-week dietary training period to reduce sodium intake to about 90 mmol/day, eight patients received 100 mmol/day sodium supplement (group 2) and eight patients a matching placebo (group 1) for 4 weeks while continuing on the reduced-sodium diet. Patients were examined at weekly intervals. Main response variables were mean values of supine and sitting systolic and diastolic blood pressure as measured in the clinic and by the patients at home. The differences in blood pressure between the beginning and the end of the blinded 4-week study period were calculated and the differences in changes between the two patient groups were regarded as the main outcome parameters. During the blinded 4-week study period, average urinary sodium excretion was 92 +/- 33 (mean +/- SD) mmol/day in group 1 and 199 +/- 52 mmol/day in group 2 (p = 0.0002). The differences in blood pressure changes between the two patient groups were 3.9(-1.2 to 9) mmHg [mean (95% confidence intervals)] for systolic home blood pressure, 0.9(-3.7 to 5.5) mmHg for diastolic home blood pressure, 4.9(-3.3 to 13.1) mmHg for clinic systolic blood pressure and 5.3(1 to 9.7 mmHg, p = 0.02) for clinic diastolic blood pressure. Combining all patients, there were relevant associations between changes of urinary sodium excretion and blood volume (Spearman correlation coefficient r = 0.57), blood pressure and angiotensin II (diastolic: r = -0.7; systolic: r = -0.48), and exchangeable body sodium and renin activity (r = -0.5). In conclusion, in this study of IDDM patients with nephropathy and high normal or mildly hypertensive blood pressure, a difference in sodium intake of about 100 mmol/day for a period of 4 weeks led to a slight reduction of clinic diastolic blood pressure. Studies including larger numbers of patients with various stages of nephropathy and hypertension are needed to definitely clarify the effects of sodium restriction in IDDM.
Authors:
I Mühlhauser; K Prange; P T Sawicki; R Bender; A Dworschak; W Schaden; M Berger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetologia     Volume:  39     ISSN:  0012-186X     ISO Abbreviation:  Diabetologia     Publication Date:  1996 Feb 
Date Detail:
Created Date:  1996-07-10     Completed Date:  1996-07-10     Revised Date:  2011-10-17    
Medline Journal Info:
Nlm Unique ID:  0006777     Medline TA:  Diabetologia     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  212-9     Citation Subset:  IM    
Affiliation:
Department of Metabolic Diseases and Nutrition (WHO-Collaborating Centre for Diabetes), Heinrich-Heine University of Düsseldorf, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aldosterone / blood
Angiotensin II / blood
Atrial Natriuretic Factor / blood
Blood Pressure / drug effects,  physiology*
Blood Volume
Diabetes Mellitus, Type 1 / blood,  diet therapy,  physiopathology*
Diabetic Nephropathies / blood,  diet therapy,  physiopathology*
Diastole
Diet, Sodium-Restricted
Energy Intake
Epinephrine / blood
Erythrocyte Volume
Hematocrit
Humans
Middle Aged
Norepinephrine / blood
Patient Education as Topic
Peptidyl-Dipeptidase A / blood
Placebos
Potassium / urine
Renin / blood
Renin-Angiotensin System / drug effects
Sodium / urine
Sodium, Dietary / pharmacology*
Statistics, Nonparametric
Systole
Chemical
Reg. No./Substance:
0/Placebos; 0/Sodium, Dietary; 11128-99-7/Angiotensin II; 51-41-2/Norepinephrine; 51-43-4/Epinephrine; 52-39-1/Aldosterone; 7440-09-7/Potassium; 7440-23-5/Sodium; 85637-73-6/Atrial Natriuretic Factor; EC 3.4.15.1/Peptidyl-Dipeptidase A; EC 3.4.23.15/Renin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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