Salt and blood pressure responses to calcium antagonism in hypertensive patients

被引:36
作者
Weir, MR
Hall, PS
Behrens, MT
Flack, JM
机构
[1] UNIV MARYLAND, SCH MED, DEPT MED, CLIN RES UNIT, BALTIMORE, MD 21201 USA
[2] WAKE FOREST UNIV, BOWMAN GRAY SCH MED, HYPERTENS CTR, DEPT SURG, WINSTON SALEM, NC USA
[3] WAKE FOREST UNIV, BOWMAN GRAY SCH MED, HYPERTENS CTR, DEPT MED, WINSTON SALEM, NC USA
[4] WAKE FOREST UNIV, BOWMAN GRAY SCH MED, HYPERTENS CTR, DEPT PUBL HLTH SCI, WINSTON SALEM, NC USA
关键词
hypertension; dietary salt; salt sensitivity;
D O I
10.1161/01.HYP.30.3.422
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Since salt intake may affect blood pressure response to antihypertensive drugs, an individual's salt-sensitivity status may be an important consideration in the selection of a medication. The purpose of this single-blind study was to assess the impact of salt sensitivity on the antihypertensive effects of isradipine. A total of 21 evaluable hypertensive patients (10 white, 11 black) 35 to 73 years of age (mean 55.9 years) were randomized to a low-salt diet (mean 24-hour urine sodium 100+/-14 mmol) or a high-salt diet (mean 24-hour urine sodium 210+/-22 mmol) for 7 weeks, followed by crossover to the other diet after a 2-week washout period. On each diet regimen, patients received placebo for 2 weeks, followed by optimal titration of isradipine (2.5 to 10 mg BID) for blood pressure control during the last 5 weeks. On the high-salt diet, salt-sensitive hypertensives (mean arterial blood pressure increase greater than or equal to 5 mm Hg, n=5) exhibited a systolic/diastolic blood pressure change of -18.7/-19.6 mm Hg from 157.2/102.9 mm Hg after 5 weeks of isradipine treatment: whereas on a low-salt diet, blood pressure change was -6.9/-12.0 mm Hg from 148.7/97.3 mm Hg. Non-salt-sensitive patients (n=16) exhibited a systolic/diastolic blood pressure change of -12.6/-7.6 mm Hg from 155.3/98.6 mm Hg on the high-salt diet and -19.2/-10.9 mm Hg from 161.6/102.6 mm Hg on the low-salt diet after treatment with isradipine. The absolute blood pressure attained in both salt-sensitive and non-salt-sensitive patients was almost identical with isradipine therapy despite variation in dietary salt, although slightly higher doses of isradipine were required in the salt-sensitive group. Consequently: isradipine, and perhaps calcium antagonists in general, manifests a more robust blood pressure-lowering effect in the setting of high sodium intake. This effect does, however, appear to be largely confined to individuals who are salt sensitive.
引用
收藏
页码:422 / 427
页数:6
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