title: Choice of Antihypertensive Combination Therapy Based on Daily Salt Intake.
abstract: BACKGROUND
  It is unclear whether thiazide diuretics (TZs) or calcium channel blockers (CCBs) are more effective as add-on therapy to angiotensin receptor blockers (ARBs) in controlling hypertension. Because TZs are a rational choice in salt-sensitive hypertension, patients with high salt intake might preferentially benefit from ARB/TZ over ARB/CCB combination therapy.
  
  
  METHODS
  Hypertensive patients who failed to reach blood pressure goals despite treatment with ARBs alone were randomly assigned to receive either ARB/TZ or ARB/CCB combination therapy. Estimated daily sodium intake was calculated from spot urine values of sodium and creatinine.
  
  
  RESULTS
  Blood pressure was measured at baseline, and at 4, 8 and 12 weeks after starting combination therapy. For all study patients (n = 87), diastolic blood pressure reduction was greater in patients receiving ARB/CCB treatment. However, in the 37 patients with a baseline estimated daily salt intake greater than 10 g and baseline systolic blood pressure (SBP) ranging from 150 to 200 mm Hg, SBP was lower (P < 0.05) and SBP reduction was greater (P < 0.05) 4 weeks after starting combination therapy in those receiving ARB/TZ treatment. In the 31 patients whose estimated daily salt intake increased at 12 weeks compared with baseline, SBP at 12 weeks was lower in those receiving ARB/TZ treatment (P < 0.05).
  
  
  CONCLUSIONS
  Estimated daily salt intake is a useful tool for guiding antihypertensive therapy and should be measured repeatedly during the therapeutic course.
authors.affiliation: Department of Cardiovascular Medicine (ST, SI, TI), Dokkyo Medical University, Mibu, Japan; Department of Clinical Research (TK), National Hospital Organization, Tochigi Medical Center, Utsunomiya, Japan; Tochigi Medical Association (ST, KT, AN, YK, AS, YA, TI), Utsunomiya, Japan; and Department of Cardiovascular Medicine (KN), Saga University, Saga, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Toyoda
authors.forename: Shu
authors.initials: S
authors.lastname: Inami
authors.forename: Toru
authors.initials: T
authors.lastname: Kato
authors.forename: Kinji
authors.initials: K
authors.lastname: Tsukada
authors.forename: Akiya
authors.initials: A
authors.lastname: Nakamoto
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kikegawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Anraku
authors.forename: Koichi
authors.initials: K
authors.lastname: Node
authors.forename: Teruo
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D024821:Metabolic Syndrome / Q000652:urine; D008875:Middle Aged; D011188:Potassium / Q000097:blood / Q000652:urine; D011446:Prospective Studies; D012964:Sodium / Q000097:blood / Q000652:urine; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents; D004232:Diuretics; D004338:Drug Combinations; D017673:Sodium Chloride, Dietary; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D000068756:Valsartan; D012964:Sodium; D014633:Valine; D011188:Potassium