title: Effects of intensive low-salt diet education on albuminuria among nondiabetic patients with hypertension treated with olmesartan: a single-blinded randomized, controlled trial.
abstract: OBJECTIVE
  The antiproteinuric effect of a renin-angiotensin-aldosterone system blockade can be magnified by dietary salt restriction. This study sought to determine the effect of intensive low-salt diet education on BP and urine albumin excretion in nondiabetic patients with hypertension and albuminuria.
  
  
  METHODS
  This study was conducted between March of 2012 and March of 2013 as an open-label, randomized, controlled trial. After a run-in period of 8 weeks, all patients received the angiotensin II receptor blocker olmesartan (40 mg daily). Patients were then divided into two groups. One group was treated for another 8 weeks with angiotensin II receptor blocker plus conventional low-salt diet education, and the other group was treated for 8 weeks with angiotensin II receptor blocker plus intensive low-salt diet education. The final analyses was performed with 245 completed patients.
  
  
  RESULTS
  The amount of daily albuminuria was significantly decreased from 0 (566.0 [25.0-5398.6] mg/d) to 8 weeks (282.5 [16.1-4898.5] mg/d; P<0.001). From 8 to 16 weeks, the 24-hour urinary sodium excretion was decreased by 36.0±5.9 mmol/d in the intensive education group and 8.8±4.9 mmol/d in the conventional education group (interaction P<0.001). Patients who completed intensive low-salt diet education exhibited greater decreases in urinary albumin excretion than the control group (change in albuminuria from 8 to 16 weeks, -154.0 versus 0.4 mg/d; P=0.01). Urinary albumin excretion tended to decrease as the 24-hour urinary sodium excretion amount decreased (R=0.32; 95% confidence interval, 0.20 to 0.43; P<0.001).
  
  
  CONCLUSIONS
  The 24-hour urinary albumin excretion was decreased more in patients in the intensive low-salt diet education group than patients in the conventional education group. Weekly intensive education on a low-salt diet would be a suitable method for clinical practice.
authors.affiliation: Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea;
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, South Korea;
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, South Korea;
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;
authors.forename: Suhnggwon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea;
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea;
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea;
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea; and.
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea cslimjy@snu.ac.kr.
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology / Q000628:therapy* / Q000652:urine; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001794:Blood Pressure; D004039:Diet, Sodium-Restricted; D005260:Female; D005502:Food; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000652:urine*; D016037:Single-Blind Method; D012964:Sodium / Q000652:urine; D012982:Sodium, Dietary; D011795:Surveys and Questionnaires; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D007093:Imidazoles; D012982:Sodium, Dietary; D013777:Tetrazoles; C437965:olmesartan; D012964:Sodium
keywords: CKD; albuminuria; angiotensin system; hypertension; nutrition; rennin