🤔 Does BP lowering matter for the kidneys after all?

Intensive BP Control in Patients with CKD and Risk for Adverse Outcomes (Ku, JASN 2023)

🤔 AT receptor action and dementia

Association of New Use of Antihypertensives That Stimulate vs Inhibit Type 2 and 4 Angiotensin II Receptors With Dementia Among Medicare Beneficiaries (Marcum, JAMA Open Network 2022)

🤔 Timing of BP medications, aka chronotherapy

Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial (Mackenzie, The Lancet 2023)

🤔 Heterogeneity in BP response

TheHeterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A randomized clinical trial (Sundstrom, JAMA 2023)

🤔 RASi + diuretics better than RASi + CCB in CKD?

A nationwide cohort study comparing the effectiveness of diuretics and calcium channel blockers on top of renin-angiotensin system inhibitors on chronic kidney disease progression and mortality (Faucon, Kidney International 2023)

🤔 Self managed BP control after pregnancy

Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial (Kitt, JAMA 2023)

✏️ Salt reduction still lowers BP

Effect of Dietary Sodium on Blood Pressure: A Crossover Trial (Gupta, JAMA 2023)

We know reducing sodium intake lowers blood pressure (BP), but what is truly the effect in those with normal BP versus high BP? Those taking BP meds versus those who do not? In the Coronary Artery Risk Development in Young Adults (CARDIA)–SSBP trial (Gupta et al, JAMA 2023), the investigators enrolled 213 individuals either with normal BP or not, and either on BP meds with controlled or uncontrolled hypertension. They crossed over from the usual diet to low sodium (diet with 500 mg i.e. ~ 25 mmol sodium) and high sodium (with 2 bouillon packets, each containing 1100 mg of sodium added to the usual diet). The low sodium diet did result in lower BP in all subgroups, by about 5 - 6 mmHg SBP in the normotensive/controlled hypertension subgroups to about 9 - 190 mmHg SBP in the uncontrolled/untreated hypertension subgroups. Though the authors say these are not significantly different based on interaction p values, the subgroups are woefully underpowered to say that. Note that diet allocation was on alternate days, so this was not a randomized trial. Additionally - despite being provided food and daily phone calls, people on low sodium couldn’t stick to the provided saltless diet (24 hour urine sodium 1.7g rather than 0.5 g) and even the high sodium group couldn’t stomach the extra 2.2g bouillon (24 hour urine sodium went up from 4.6 to 5.5 rather than expected 6.8 g/day). So, an extremely low sodium diet does lower BP a bit, but it’s hard to achieve even if you are provided the food. Salt substitutes are so much more pragmatic! 

Swapnil Hiremath

🤔 Does intensive BP Lowering worsen orthostatic hypotension?

Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease. An Individual Participant Meta-Analysis (Juraschek, JAMA 2023)

Intensive BP control in Elderly - Visual Abstract

Intensive blood pressure control in hospitalized older adults beneficial or detrimental?

NSMC intern Melvin Chan explains with a visual abstract

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Diagnosing Aldosteronism Visual Abstract

Samira Farouk did a great job with this week’s Visual Abstract

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