Comparative Efficacy of Antihypertensive Agents in Salt-Sensitive Hypertensive Patients: A Network Meta-Analysis

Han, Qin; Liu, Zheng; Cao, Han; Sun, Weiping; Peng, Wei; Liu, Bin; Dong, Shengjie; Xiang, Yu‐Tao

doi:10.1093/ajh/hpy027

Cited by 18 publications

(10 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding drug therapy, it has been reported that hydrochlorothiazide, or a combination of hydrochlorothiazide and CCB, has a superior salt-reducing effect among antihypertensive agents [ 23 , 24 ]. Furthermore, it has been reported that the combination of metformin and CCB is also useful in patients with obesity [ 24 ], and this treatment might be worth further investigation in the future, especially in obese patients with type 2 diabetes. However, it has also been suggested that low salt intake among patients with heart failure may result in unintended nutritional problems (undernutrition and lack of electrolytes and trace elements) [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Simple Salt Reduction Instructions by Physician for Patients with Type 2 Diabetes Consuming Excessive Salt

Oyabu

Ushigome

Ono

et al. 2021

IJERPH

View full text Add to dashboard Cite

Objectives: We verified the clinical usefulness of an approach method in which a physician gives simple salt reduction instructions during outpatient visits to patients with type 2 diabetes. Methods: This study was an open-blind, randomized controlled trial. Subjects were outpatients with type 2 diabetes whose estimated salt intake using spot morning urine sample exceeded the target of salt intake. The control group (CG) was notified only of the current salt intake, whereas the intervention group (IG) was given the brief salt reduction instruction by a physician in addition to the information regarding their current salt intake. Results: The change in estimated salt intake was −0.6 g (from 10.1 to 9.5 g, p = 0.029) in the CG after 8 weeks, and −0.9 g (from 10.1 to 9.2 g, p = 0.001) in the IG, although there were no significant differences between them (p = 0.47). After 24 weeks, both groups no longer differed significantly from the baseline. In addition, multivariate linear regression analyses indicated that high salt intake and low estimated glomerular filtration rate at baseline were significantly associated with salt reduction after 8 weeks. Conclusions: Salt-reducing effects were observed after 8 weeks in both the IG and CG, but no significant difference was observed. Moreover, patients with high salt intake and renal disfunction may be more effective in accepting salt reduction instructions. Making patients aware of the importance of salt reduction through a physician is effective for continuous salt reduction, and it is important to continue regular and repetitive guidance.

show abstract

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Simple Salt Reduction Instructions by Physician for Patients with Type 2 Diabetes Consuming Excessive Salt

Oyabu

Ushigome

Ono

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…Высказывается мнение о том, что воздействие соли на уровень АД зависит не только от активности ее потребления, но и от индивидуальной чувствительности к ней, которая может рассматриваться и как независимый фактор риска поражения органов-мишеней при АГ, и как фактор риска неблагоприятного течения ССЗ [19]. Исходя из этого диуретики представляют собой незаменимый класс АГП при лечении широкого спектра пациентов с АГ, в особенности при наличии у них ожирения, а также у лиц старших возрастных групп [20].…”

Section: обоснование выбора комбинации агтunclassified

Tactics of antihypertensive therapy during COVID-19 pandemic

Подзолков

Брагина

Rodionova

et al. 2021

Terapevticheskii arkhiv

View full text Add to dashboard Cite

Results of foreign and Russian studies indicate a higher mortality rate of patients with concomitant cardiovascular diseases (CVD) due to the new coronavirus infection COVID-19. It has been proven that arterial hypertension, as one of the significant risk factors for the development of concomitant cardiovascular diseases, is associated with a more severe prognosis of COVID-19. This article presents the results of modern studies and large meta-analyzes of necessity and safety of the use of blockers of the renin-angiotensin-aldosterone system in patients with arterial hypertension and COVID-19. The data of studies show that an angiotensin-converting enzyme inhibitor (ACE inhibitor) and a thiazide-like diuretic is a pathogenetically rational combination. It realizes various ways of lowering blood pressure by reducing the activity of the renin-angiotensin-aldosterone system, which is achieved by using an ACE inhibitor, and natriuresis due to diuretics. As an example, a highly effective fixed combination of drugs is considered, characterized by good tolerance, which consists of an ACE inhibitor lisinopril and a thiazide-like diuretic indapamide of prolonged action. The authors expressed the opinion that the appointment of the fixed combination drug Diroton Plus (Gedeon Richter) will contribute to effective control of blood pressure and organoprotection in conditions of increased thrombogenic and prooxidative potential, characteristic of COVID-19 both in the acute stage and within the post-COVID Syndrome.

show abstract

“…Кроме того, эффективность лечения, особенно при сочетании АГ и СД 2 типа, во многом зависит от такого феномена, как солечувствительность пациентов. Важно, что сама по себе чувствительность к поваренной соли способствует увеличению жесткости сосудистой стенки, ЦАД, и, как результат, развитию кардиоваскулярных событий [5].…”

Section: Chrono-pharmacotherapy Of Hypertension and Dm Typeunclassified

Effectiveness of Chrono-Pharmacotherapy Depending on the Salt Sensitivity of Patients with Arterial Hypertension and Diabetes Mellitus Type 2

Skibitskiy

Kiselev

Фендрикова

2019

Racionalʹnaâ farmakoterapiâ v kardiologii

View full text Add to dashboard Cite

Aim. To study the effect of two regimens of combined antihypertensive therapy during the day on daily monitoring of arterial pressure, central aortic pressure, and arterial stiffness, depending on the salt sensitivity of hypertensive patients with diabetes mellitus type 2. Material and methods. 130 hypertensive patients with type 2 diabetes mellitus were included into the study. They were divided into 2 subgroups: salt-sensitive (group 1) and salt-resistant (group 2), and then randomized to subgroups A and B of ongoing therapy: in the morning ramipril and indapamide retard, bedtime – amlodipine (subgroup 1A and 2A); or in the morning amlodipine and indapamide retard, bedtime – ramipril (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, 24-hour blood pressure monitoring was performed, the indices of central aortic pressure and arterial stiffness were determined. Results. After 24 weeks, in all subgroups, there was a significant positive dynamics of the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices. In the subgroup 1В, it was registered a significant improvement in the majority of parameters of 24-hour blood pressure monitoring (decrease in 24-hours systolic BP by 24.4%, 24-hours diastolic BP by 22.1%; p<0.05), central aortic pressure (decrease in aortal systolic BP by 15.9%, aortal diastolic BP by 20.8%; p<0.05) and vascular wall stiffness parameters (decrease in pulse wave velocity by 13.8%; p<0.05) in comparison with group 1A (decrease in 24-hours systolic BP by 17.5%, 24-hours diastolic BP by 14.6%, aortal systolic BP by 12.7%, aortal diastolic BP by 9.7%, pulse wave velocity by 9.2%; p<0.05 in comparison with the group 1B). In the case of salt-resistant patients, there were comparable positive changes in the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices against the background of both dosing regimens during the day. Conclusion. In the study, it was demonstrated the more pronounced antihypertensive and vasoprotective efficacy of the combination of thiazide-like diuretic with calcium channel blocker in the morning and ACE inhibitor in bedtime compared to the alternative regimen of prescribed pharmacotherapy in salt-sensitive patients, and comparable efficacy of both regimens in salt-resistant hypertensive patients with diabetes mellitus type 2.

show abstract

Comparative Efficacy of Antihypertensive Agents in Salt-Sensitive Hypertensive Patients: A Network Meta-Analysis

Abstract: For SSH patients with no concomitant diseases, CCB combined with hydrochlorothiazide and moderate salt intake was optimal in reducing BP, while CCB combined with metformin and moderate salt intake was the most efficacious at reducing BP in SSH patients with coexisting obesity.

Cited by 18 publications

References 37 publications

Randomized Controlled Trial of Simple Salt Reduction Instructions by Physician for Patients with Type 2 Diabetes Consuming Excessive Salt

Randomized Controlled Trial of Simple Salt Reduction Instructions by Physician for Patients with Type 2 Diabetes Consuming Excessive Salt

Tactics of antihypertensive therapy during COVID-19 pandemic

Effectiveness of Chrono-Pharmacotherapy Depending on the Salt Sensitivity of Patients with Arterial Hypertension and Diabetes Mellitus Type 2

Contact Info

Product

Resources

About