Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers

Hiddo J. Lambers Heerspink*, Frank A. Holtkamp, Hans-Henrik Parving, Gerjan J. Navis, Julia B. Lewis, Eberhard Ritz, Pieter A. de Graeff, Dick de Zeeuw

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

160 Citations (Scopus)

Abstract

Dietary sodium restriction has been shown to enhance the short-term response of blood pressure and albuminuria to angiotensin receptor blockers (ARBs). Whether this also enhances the long-term renal and cardiovascular protective effects of ARBs is unknown. Here we conducted a post-hoc analysis of the RENAAL and IDNT trials to test this in patients with type 2 diabetic nephropathy randomized to ARB or non-renin-angiotensin-aldosterone system (non-RAASi)-based antihypertensive therapy. Treatment effects on renal and cardiovascular outcomes were compared in subgroups based on dietary sodium intake during treatment, measured as the 24-h urinary sodium/creatinine ratio of 1177 patients with available 24-h urinary sodium measurements. ARB compared to non-RAASi-based therapy produced the greatest long-term effects on renal and cardiovascular events in the lowest tertile of sodium intake. Compared to non-RAASi, the trend in risk for renal events was significantly reduced by 43%, not changed, or increased by 37% for each tertile of increased sodium intake, respectively. The trend for cardiovascular events was significantly reduced by 37%, increased by 2% and 25%, respectively. Thus, treatment effects of ARB compared with non-RAASi-based therapy on renal and cardiovascular outcomes were greater in patients with type 2 diabetic nephropathy with lower than higher dietary sodium intake. This underscores the avoidance of excessive sodium intake, particularly in type 2 diabetic patients receiving ARB therapy. Kidney International (2012) 82, 330-337; doi:10.1038/ki.2012.74; published online 21 March 2012

Original languageEnglish
Pages (from-to)330-337
Number of pages8
JournalKidney International
Volume82
Issue number3
DOIs
Publication statusPublished - Aug-2012

Keywords

  • angiotensin receptor blockers
  • diabetic nephropathy
  • dietary sodium
  • type 2 diabetes
  • GLOMERULAR-FILTRATION-RATE
  • CONVERTING ENZYME-INHIBITION
  • CHRONIC KIDNEY-DISEASE
  • DIABETIC-NEPHROPATHY
  • TYPE-2 DIABETES/
  • SERUM CREATININE
  • CONTROLLED-TRIAL
  • ACE-INHIBITION
  • LOSARTAN
  • RATS

Cite this