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Effects of high sodium intake and diuretics on the circadian rhythm of blood pressure in type 2 diabetic patients treated with an angiotensin II receptor blocker

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Clinical and Experimental Nephrology Aims and scope Submit manuscript

An Erratum to this article was published on 01 August 2009

Abstract

Backgrounds

The inhibition of the renin-angiotensin system in the diabetic condition was reported to enhance the sodium sensitivity of blood pressure. In patients with sodium-sensitive hypertension, high sodium intake reduces the nocturnal fall in blood pressure. Therefore, we examined the effects of the amount of sodium intake or diuretics in patients with diabetes treated with an angiotensin receptor blocker.

Methods

We recruited 32 Japanese type 2 diabetic patients with base line blood pressure ≥130/80 mmHg and treated with valsartan (80 mg daily). At baseline, 24-h ambulatory blood pressure and 24-h urinary excretion of sodium were measured. The patients were then randomly assigned to take either combination therapy with 50 mg of losartan plus 12.5 mg of hydrochlorothiazide or monotherapy with 160 mg of valsartan for 24 weeks.

Results

At baseline, 22 of 32 (69%) patients were classified as non-dippers, and the night/day ratio of mean arterial pressure was significantly correlated with 24-h urinary sodium excretion. The combination therapy resulted in a significantly higher fall than the monotherapy in 24-h mean, daytime, night-time and morning blood pressures. The night/day ratio of mean arterial pressure was significantly reduced from the baseline at the end of the study in the combination therapy group, but not in the monotherapy group. In non-dipper patients, the diminished nocturnal fall in blood pressure was restored by the combination therapy.

Conclusions

Excessive intake of salt causes non-dipping and diuretics restored nocturnal BP fall in type 2 diabetic patients treated with angiotensin 2 receptor blockers.

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Authors and Affiliations

  1. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

    Takashi Uzu, Masayoshi Sakaguchi, Yukiyo Yokomaku, Shinji Kume, Masami Kanasaki, Keiji Isshiki, Shin-ichi Araki, Toshiro Sugiomoto & Atsunori Kashiwagi

  2. Division of Endocrinology and Metabolism, Department of Medicine, Kanazawa Medical University, Kanazawa, Japan

    Daisuke Koya

  3. Department of Medicine, Asahikawa Medical College, Asahikawa, Japan

    Masakazu Haneda

Authors
  1. Takashi Uzu
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  2. Masayoshi Sakaguchi
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  3. Yukiyo Yokomaku
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  4. Shinji Kume
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Correspondence to Takashi Uzu.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s10157-009-0185-3

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Uzu, T., Sakaguchi, M., Yokomaku, Y. et al. Effects of high sodium intake and diuretics on the circadian rhythm of blood pressure in type 2 diabetic patients treated with an angiotensin II receptor blocker. Clin Exp Nephrol 13, 300–306 (2009). https://doi.org/10.1007/s10157-009-0157-7

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  • DOI: https://doi.org/10.1007/s10157-009-0157-7

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