Nephrology Dialysis Transplantation, Vol 13, Issue 7 1682-1685, Copyright © 1998 by Oxford University Press
H Buter, M Hemmelder, G Navis, P de Jong and D de Zeeuw
Background: Dietary sodium restriction enhances the
antiproteinuric and blood pressure lowering effect of ACE inhibition. In
clinical practice, however, long-term compliance to a low-sodium diet may
be difficult to obtain. We therefore investigated whether the blunting of
the antiproteinuric and blood pressure lowering efficacy of ACE inhibition
by high sodium intake can be restored by the addition of a diuretic.
Patients and methods: Seven proteinuric patients with
non-diabetic renal disease on chronic ACE inhibition were studied during
three consecutive 4-week periods: low sodium (50 mmol/day), high sodium
(200 mmol/day) and high sodium plus hydrochlorothiazide (50 mg o.i.d.).
Results: During low sodium intake proteinuria was 3.1
(0.7-5.2) g/day, during high sodium intake proteinuria increased to 4.5
(1.6-9.2) g/day (P<0.05). Interestingly, addition of
hydrochlorothiazide again reduced proteinuria to 2.8 (0.6-5.8) g/day
(P<0.05). Mean arterial blood pressure was 89 (84-96), 98 (91-104)
and 89 (83-94) mmHg (P<0.05) during the three periods, respectively.
Conclusion: Addition of hydrochlorothiazide can
overcome the blunting of the therapeutic efficacy of ACE inhibition on
proteinuria and blood pressure by a high sodium intake. Key
words: ACE inhibition; hydrochlorothiazide; non-diabetic renal
disease; proteinuria; sodium restriction
ORIGINAL ARTICLES
The blunting of the antiproteinuric efficacy of ACE inhibition by high sodium intake can be restored by hydrochlorothiazide
Groningen Institute for Drug Studies (GIDS), Divisions of Nephrology and Clinical Pharmacology, State University Hospital, Groningen, The Netherlands; Corresponding author at: Division of Nephrology, Department of Medicine, State University Hospital, Hanzelplein 1, 9713 GZ Groningen, The Netherlands
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