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Type: Journal article
Title: Effect of angiotensin II receptor blocker and salt supplementation on short-term blood pressure variability in type 2 diabetes
Author: Chen, A.X.
Moran, J.L.
Libianto, R.
Baqar, S.
O Callaghan, C.
MacIsaac, R.J.
Jerums, G.
Ekinci, E.I.
Citation: Journal of Human Hypertension, 2019; 34(2):143-150
Publisher: Springer Nature
Issue Date: 2019
ISSN: 0950-9240
Statement of
Angela X. Chen, John L. Moran, Renata Libianto, Sara Baqar, Christopher O'Callaghan, Richard J. MacIsaac, George Jerums, Elif I. Ekinci
Abstract: High blood pressure variability (BPV) has been associated with increased cardiovascular (CV) risk. The effect of dietary salt and renin-angiotensin-aldosterone system (RAAS) activity on short-term BPV in type 2 diabetes mellitus (T2DM) is not well characterised. We aimed to determine the effect of dietary salt (sodium chloride, NaCl) supplementation on 24-h mean arterial BPV (24hBPV) during angiotensin II receptor blocker (telmisartan) use and to evaluate the effects of age, sex, plasma renin activity (PRA) and serum aldosterone on 24hBPV. In a randomised, double-blind, crossover study, patients with T2DM (n = 28), treated with telmisartan received NaCl (100 mmol/24 h) or placebo capsules during 2 weeks of telmisartan. Following a 6-week washout, the protocol was repeated in reverse. 24hBPV was evaluated as a co-efficient of variation [CV (%) = mean/standard deviation] × 100). Twenty-four hour urinary sodium excretion, ambulatory BP and biochemical tests were performed at each phase. Results were analysed using a linear mixed model to generate predicted values for 24hBPV. Predicted 24hBPV was higher with telmisartan vs baseline (p = 0.01), with a trend towards reduced 24hBPV with salt (p = 0.052). Predicted 24hBPV was lower in females (p = 0.017), increasing age (p = 0.001) and increasing PRA (p = 0.011). In patients with T2DM, predicted 24hBPV increased from baseline with telmisartan, but there was no additional increase in predicted 24hBPV with salt supplementation. This suggests that in the short-term, salt supplementation has no apparent deleterious effects on 24hBPV. Long-term studies are required to evaluate the effect of 24hBPV on CV outcomes in patients with T2DM.
Keywords: Humans
Diabetes Mellitus, Type 2
Sodium Chloride
Sodium Chloride, Dietary
Angiotensin II
Cross-Over Studies
Renin-Angiotensin System
Blood Pressure
Dietary Supplements
Angiotensin Receptor Antagonists
Rights: © The Author(s), under exclusive licence to Springer Nature Limited 2019.
DOI: 10.1038/s41371-019-0238-3
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