(Hypertension. 1997;30:422.)
© 1997 American Heart Association, Inc.
Articles |
Salt and Blood Pressure Responses to Calcium Antagonism in Hypertensive Patients
From the Division of Nephrology and the Clinical Research Unit, Department of Medicine, University of Maryland School of Medicine (Baltimore) (M.R.W., P.S.H., M.T.B.); and the Hypertension Center, Departments of Surgery, Medicine, and Public Health Sciences, Bowman-Gray School of Medicine, Winston-Salem, NC (J.M.F.).
Correspondence to Matthew R. Weir, MD, University of Maryland School of Medicine, Department of Medicine, Nephrology Division, 22 S Greene St, Baltimore, MD 21201-1595. E-mail mweir{at}ummpa.ab.umd.edu
Abstract 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
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 161.0/102.6 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.
Key Words: hypertension • dietary salt • salt sensitivity
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