From the Division of Nephrology and Clinical Research Unit, Department of
Medicine, University of Maryland School of Medicine, Baltimore (M.R.W.);
Oklahoma Cardiovascular and Hypertension Center, Oklahoma City (S.G.C.);
Division of Nephrology, Hypertension, and Clinical Pharmacology at Oregon
Health Sciences University, Portland (D.A.M.); Miami Heart Research Institute
(Fla) (M.C.-T.); St Louis University Health Sciences Center (Mo) (J.D.C);
Sandoz Pharmaceuticals Corporation, East Hanover, NJ (P.A.G., R.F.M.);
National Research Institute, Los Angeles, Calif (A.J.L.); Hill Top Research,
Tacoma, Wash (L.W.K.); Division of Endocrinology, Department of Medicine,
Baltimore Veterans Affairs Medical Center (Md) (J.H.H.); Division of
Hypertension, Department of Medicine, University of Indiana School of
Medicine, Indianapolis (M.H.W.); and Division of Hypertension, Department of
Medicine, University of Michigan School of Medicine, Ann Arbor (A.B.W.).
Abstract—Dietary salt
restriction is a recommended adjunct with antihypertensive therapy.
There may be racial differences in blood pressure response to salt
restriction while on antihypertensive therapy. We performed a
multicenter, randomized, double-blind, placebo-controlled,
parallel-group clinical trial (black, n=96; Hispanic, n=63; white,
n=232). Participants were initially preselected for stage I to III
hypertension and then further selected for salt sensitivity (
© 1998 American Heart Association, Inc.
Scientific Contributions
Influence of Race and Dietary Salt on the Antihypertensive Efficacy of an Angiotensin-Converting Enzyme Inhibitor or a Calcium Channel Antagonist in Salt-Sensitive Hypertensives
5
mm Hg increase in diastolic blood pressure after 3 weeks
of low salt [
88 mmol/d Na+] and high salt
[>190 mmol/d Na+] diet). We compared the
antihypertensive effect of an angiotensin-converting enzyme
inhibitor (enalapril 5 or 20 mg BID) or a calcium channel
antagonist (isradipine 5 or 10 mg BID) during alternating
periods of high and low salt intake. The main outcome measure was blood
pressure change and absolute blood pressure level achieved with
therapy. During the high salt diet (314.7±107.5 mmol/d urinary
Na+) there was greater downward change in blood pressure
with both enalapril and isradipine compared with the low salt diet
(90.1±50.8 mmol/d Na+); however, the absolute blood
pressure achieved in all races was consistently lower on a low
salt diet for both agents. Black, white, and Hispanic
isradipine-treated salt-sensitive hypertensives demonstrated a smaller
difference between high and low salt diets (black, -3.6/-1.6
mm Hg; white, -6.2/-3.9 mm Hg; Hispanic, -8.1/-5.3
mm Hg) than did enalapril-treated patients (black, -9.0/-5.3
mm Hg; white, -11.8/-7.0 mm Hg; Hispanic, -11.1/-5.6
mm Hg). On the low salt diet, blacks, whites, and Hispanics had
similar blood pressure control with enalapril and isradipine. On the
high salt diet, blacks had better blood pressure control with
isradipine than with enalapril, whereas there was no difference in the
blood pressure control in whites and Hispanics treated with either
drug. Dietary salt reduction helps reduce blood pressure in
salt-sensitive hypertensive blacks, whites, and Hispanics treated with
enalapril or isradipine. These data demonstrate that controlling for
salt sensitivity diminishes race-related differences in
antihypertensive activity.
Key Words: sodium, dietary • race • angiotensin-converting enzyme inhibitors • calcium channels
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