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Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan.

Abstract
There is large interindividual variability in the antiproteinuric response to blockade of the renin-angiotensin-aldosterone system (RAAS). A low-sodium diet or addition of diuretics enhances the effects of RAAS blockade on proteinuria and BP, but the efficacy of the combination of these interventions is unknown. Therefore, this randomized, double-blind, placebo-controlled trial to determine the separate and combined effects of a low-sodium diet and hydrochlorothiazide (HCT) on proteinuria and BP was performed. In 34 proteinuric patients without diabetes, mean baseline proteinuria was 3.8 g/d, and this was reduced by 22% by a low-sodium diet alone. Losartan monotherapy reduced proteinuria by 30%, and the addition of a low-sodium diet led to a total reduction by 55% and the addition of HCT to 56%. The combined addition of HCT and a low-sodium diet reduced proteinuria by 70% from baseline (all P < 0.05). Reductions in mean arterial pressure showed a similar pattern (all P < 0.05). In addition, individuals who did not demonstrate an antiproteinuric response to losartan monotherapy did respond when a low-sodium diet or a diuretic was added. In conclusion, a low-sodium diet and HCT are equally efficacious in reducing proteinuria and BP when added to a regimen containing losartan and especially seem to benefit individuals who are resistant to RAAS blockade. Combining these interventions in sodium status is an effective method to maximize the antiproteinuric efficacy of RAAS blockade.
AuthorsLiffert Vogt, Femke Waanders, Frans Boomsma, Dick de Zeeuw, Gerjan Navis
JournalJournal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 19 Issue 5 Pg. 999-1007 (May 2008) ISSN: 1533-3450 [Electronic] United States
PMID18272844 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antihypertensive Agents
  • Lipids
  • Serum Albumin
  • Sodium Chloride, Dietary
  • Hydrochlorothiazide
  • Uric Acid
  • Aldosterone
  • Renin
  • Losartan
  • Potassium
Topics
  • Adult
  • Aged
  • Aldosterone (blood)
  • Antihypertensive Agents (administration & dosage)
  • Blood Pressure (drug effects)
  • Cross-Over Studies
  • Drug Interactions
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hydrochlorothiazide (administration & dosage)
  • Lipids (blood)
  • Losartan (administration & dosage)
  • Male
  • Middle Aged
  • Patient Compliance
  • Potassium (blood)
  • Proteinuria (diet therapy, drug therapy, metabolism)
  • Renin (blood)
  • Renin-Angiotensin System (drug effects)
  • Serum Albumin
  • Sodium Chloride, Dietary (administration & dosage)
  • Uric Acid (blood)

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