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Title: Effect of angiotensin II receptor blocker and salt supplementation on short-term blood pressure variability in type 2 diabetes.
Austin Authors: Chen, Angela X;Moran, John L;Libianto, Renata;Baqar, Sara;O'Callaghan, Christopher;MacIsaac, Richard J;Jerums, George ;Ekinci, Elif I 
Affiliation: Endocrinology
Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Queen Elizabeth Hospital, Adelaide, SA, Australia
Clinical Pharmacology and Therapeutics
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Feb-2020
Date: 2019-09-09
Publication information: Journal of Human Hypertension 2020; 34(2): 143-150
Abstract: High blood pressure variability (BPV) has been associated with increased cardiovascular (CV) risk. The effect of dietary salt and renin-angiotensin-aldosterone system (RAAS) activity on short-term BPV in type 2 diabetes mellitus (T2DM) is not well characterised. We aimed to determine the effect of dietary salt (sodium chloride, NaCl) supplementation on 24-h mean arterial BPV (24hBPV) during angiotensin II receptor blocker (telmisartan) use and to evaluate the effects of age, sex, plasma renin activity (PRA) and serum aldosterone on 24hBPV. In a randomised, double-blind, crossover study, patients with T2DM (n = 28), treated with telmisartan received NaCl (100 mmol/24 h) or placebo capsules during 2 weeks of telmisartan. Following a 6-week washout, the protocol was repeated in reverse. 24hBPV was evaluated as a co-efficient of variation [CV (%) = mean/standard deviation] × 100). Twenty-four hour urinary sodium excretion, ambulatory BP and biochemical tests were performed at each phase. Results were analysed using a linear mixed model to generate predicted values for 24hBPV. Predicted 24hBPV was higher with telmisartan vs baseline (p = 0.01), with a trend towards reduced 24hBPV with salt (p = 0.052). Predicted 24hBPV was lower in females (p = 0.017), increasing age (p = 0.001) and increasing PRA (p = 0.011). In patients with T2DM, predicted 24hBPV increased from baseline with telmisartan, but there was no additional increase in predicted 24hBPV with salt supplementation. This suggests that in the short-term, salt supplementation has no apparent deleterious effects on 24hBPV. Long-term studies are required to evaluate the effect of 24hBPV on CV outcomes in patients with T2DM.
DOI: 10.1038/s41371-019-0238-3
ORCID: 0000-0002-5760-939X
Journal: Journal of Human Hypertension
PubMed URL: 31501493
Type: Journal Article
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