Short-term dietary salt supplementation blunts telmisartan induced increases in plasma renin activity in hypertensive patients with type 2 diabetes mellitus

Angela X. Chen, George Jerums, Sara Baqar, Elisabeth Lambert, Goji Somarajah, Georgina Thomas, Christopher O'Callaghan, Richard J. MacIsaac, Elif I. Ekinci

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)415-422
Number of pages8
JournalClinical Science
Volume129
Issue number5
DOIs
Publication statusPublished - Sep 2015
Externally publishedYes

Keywords

  • Angiotensin receptor blocker
  • Hypertension
  • Renin angiotensin aldosterone activity
  • Salt
  • Sodium
  • Type 2 diabetes

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