Jin Ho Hwang1, Ho Jun Chin2, Sejoong Kim2, Dong Ki Kim3, Suhnggwon Kim3, Jung Hwan Park4, Sung Joon Shin5, Sang Ho Lee6, Bum Soon Choi7, Chun Soo Lim8. 1. Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea; 2. Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, South Korea; 3. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; 4. Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea; 5. Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; 6. Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea; 7. Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea; and. 8. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea cslimjy@snu.ac.kr.
Abstract
BACKGROUND AND OBJECTIVES: 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. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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.
RCT Entities:
BACKGROUND AND OBJECTIVES: 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 nondiabeticpatients with hypertension and albuminuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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: 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 Journal: Kidney Int Date: 2012-03-21 Impact factor: 10.612
Authors: F Locatelli; D Marcelli; M Comelli; D Alberti; G Graziani; G Buccianti; B Redaelli; A Giangrande Journal: Nephrol Dial Transplant Date: 1996-03 Impact factor: 5.992
Authors: P R Conlin; D Chow; E R Miller; L P Svetkey; P H Lin; D W Harsha; T J Moore; F M Sacks; L J Appel Journal: Am J Hypertens Date: 2000-09 Impact factor: 2.689
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
Authors: Alex R Chang; Lisa Bailey-Davis; Vonda Hetherington; Anna Ziegler; Christina Yule; Sara Kwiecen; Elisabeth Graboski; Melissa M Melough; Charlotte Collins; Cheryl Anderson Journal: J Ren Nutr Date: 2019-05-08 Impact factor: 3.655
Authors: Sarah J Schrauben; Apurva Inamdar; Christina Yule; Sara Kwiecien; Caitlin Krekel; Charlotte Collins; Cheryl Anderson; Lisa Bailey-Davis; Alex R Chang Journal: J Ren Nutr Date: 2021-10-11 Impact factor: 3.655
Authors: Maria E Marketou; Spyros Maragkoudakis; Ioannis Anastasiou; Helen Nakou; Marina Plataki; Panos E Vardas; Fragiskos I Parthenakis Journal: J Clin Hypertens (Greenwich) Date: 2019-04-19 Impact factor: 3.738
Authors: Marguerite M Conley; Catherine M McFarlane; David W Johnson; Jaimon T Kelly; Katrina L Campbell; Helen L MacLaughlin Journal: Cochrane Database Syst Rev Date: 2021-03-30
Authors: Seung Seok Han; Eunjin Bae; Shin Young Ahn; Sejoong Kim; Jung Hwan Park; Sung Joon Shin; Sang Ho Lee; Bum Soon Choi; Ho Jun Chin; Chun Soo Lim; Suhnggwon Kim; Dong Ki Kim Journal: BMC Nephrol Date: 2015-08-01 Impact factor: 2.388