Current guidelines recommend low dietary salt intake (LDS) in patients with diabetes to reduce blood pressure (BP). However, low salt intake has been associated with higher mortality rates in people with diabetes. Our aim is to examine the effect of angiotensin II receptor blocker (ARB), telmisartan, with and without dietary sodium chloride (NaCl) supplementation, on BP [mean arterial pressure (MAP)], plasma renin activity (PRA), serum aldosterone level and estimated glomerular filtration rate (eGFR) in hypertensive patients with type 2 diabetes. In a randomized, double-blind, placebo-controlled study (RCT), 28 patients with type 2 diabetes, treated with telmisartan (40 mg daily), received 2 weeks of placebo or NaCl capsules (100 mmol/24 h). Following a 6-week washout, the protocol was repeated in reverse. Twenty-four-hour urinary sodium excretion (24hUNa), ambulatory BP (ABP) monitoring and blood tests were performed before and after each study phase. The telmisartan-associated increase in PRA was blunted by approximately 50% during salt supplementation compared with placebo; median PRA was 2.3 μg/l/h with placebo compared with 1.7 μg/l/h with salt (P<0.001). A trend towards blunting of ARB induced increases in serum aldosterone was also demonstrated. Salt supplementation significantly reduced the MAP lowering effects of telmisartan (P<0.05). The present study demonstrates that salt supplementation blunts the telmisartan induced increase in PRA in patients with type 2 diabetes.
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September 2015
Research Article|
June 11 2015
Short-term dietary salt supplementation blunts telmisartan induced increases in plasma renin activity in hypertensive patients with type 2 diabetes mellitus
Angela X. Chen;
Angela X. Chen
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
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George Jerums;
George Jerums
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
†Department of Medicine, The University of Melbourne, Parkville 3010, Australia
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Sara Baqar;
Sara Baqar
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
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Elisabeth Lambert;
Elisabeth Lambert
‡Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia
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Goji Somarajah;
Goji Somarajah
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
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Georgina Thomas;
Georgina Thomas
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
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Christopher O’Callaghan;
Christopher O’Callaghan
§Department of Clinical Pharmacology, Austin Health, Heidelberg 3084, Australia
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Richard J. MacIsaac;
Richard J. MacIsaac
†Department of Medicine, The University of Melbourne, Parkville 3010, Australia
║Department of Endocrinology and Diabetes, St Vincent's Health, Fitzroy 3065, Australia
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Elif I. Ekinci
*Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
†Department of Medicine, The University of Melbourne, Parkville 3010, Australia
¶Menzies School of Public Health Research, Darwin 0811, Australia
Correspondence: Dr Elif Ekinci (email elif.ekinci@unimelb.edu.au).
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Clin Sci (Lond) (2015) 129 (5): 415–422.
Article history
Received:
September 08 2014
Revision Received:
April 07 2015
Accepted:
April 07 2015
Accepted Manuscript online:
April 07 2015
Citation
Angela X. Chen, George Jerums, Sara Baqar, Elisabeth Lambert, Goji Somarajah, Georgina Thomas, Christopher O’Callaghan, Richard J. MacIsaac, Elif I. Ekinci; Short-term dietary salt supplementation blunts telmisartan induced increases in plasma renin activity in hypertensive patients with type 2 diabetes mellitus. Clin Sci (Lond) 1 September 2015; 129 (5): 415–422. doi: https://doi.org/10.1042/CS20140536
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