Document Detail

Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes.
MedLine Citation:
PMID:  20372874     Owner:  NLM     Status:  MEDLINE    
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.
E I Ekinci; G Thomas; R J MacIsaac; C Johnson; C Houlihan; S Panagiotopoulos; E Premaratne; H Hao; S Finch; C O'Callaghan; G Jerums
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-04-07
Journal Detail:
Title:  Diabetologia     Volume:  53     ISSN:  1432-0428     ISO Abbreviation:  Diabetologia     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-05-27     Completed Date:  2010-08-27     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0006777     Medline TA:  Diabetologia     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1295-303     Citation Subset:  IM    
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MeSH Terms
Antihypertensive Agents* / pharmacology,  therapeutic use
Benzimidazoles* / pharmacology,  therapeutic use
Benzoates* / pharmacology,  therapeutic use
Blood Pressure / drug effects*
Diabetes Mellitus, Type 2 / drug therapy,  physiopathology*
Double-Blind Method
Hydrochlorothiazide* / pharmacology,  therapeutic use
Hypertension / drug therapy*
Middle Aged
Sodium Chloride, Dietary / pharmacology,  therapeutic use*
Reg. No./Substance:
0/Antihypertensive Agents; 0/Benzimidazoles; 0/Benzoates; 0/Sodium Chloride, Dietary; 0J48LPH2TH/Hydrochlorothiazide; U5SYW473RQ/telmisartan

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