title: Short-term dietary salt supplementation blunts telmisartan induced increases in plasma renin activity in hypertensive patients with type 2 diabetes mellitus.
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.
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia.
authors: Angela X
authors: AX
authors: Chen
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia Department of Medicine, The University of Melbourne, Parkville 3010, Australia.
authors: George
authors: G
authors: Jerums
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia.
authors: Sara
authors: S
authors: Baqar
authors: Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia.
authors: Elisabeth
authors: E
authors: Lambert
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia.
authors: Goji
authors: G
authors: Somarajah
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia.
authors: Georgina
authors: G
authors: Thomas
authors: Department of Clinical Pharmacology, Austin Health, Heidelberg 3084, Australia.
authors: Christopher
authors: C
authors: O'Callaghan
authors: Department of Medicine, The University of Melbourne, Parkville 3010, Australia Department of Endocrinology and Diabetes, St Vincent's Health, Fitzroy 3065, Australia.
authors: Richard J
authors: RJ
authors: MacIsaac
authors: Department of Endocrinology, Austin Health, Heidelberg 3084, Australia Department of Medicine, The University of Melbourne, Parkville 3010, Australia Menzies School of Public Health Research, Darwin 0811, Australia elif.ekinci@unimelb.edu.au.
authors: Elif I
authors: EI
authors: Ekinci
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D017673:Sodium Chloride, Dietary / Q000009:adverse effects*; D000077333:Telmisartan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D015415:Biomarkers; D017673:Sodium Chloride, Dietary; D012083:Renin; D000077333:Telmisartan
keywords: angiotensin receptor blocker; hypertension; renin angiotensin aldosterone activity; salt; sodium; type 2 diabetes