Response to Letter to Editor
Response to “Hazard of Low Salt Intake” Michael H. Alderman1
Correspondence: Michael H. Alderman ([email protected]). 1Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
Initially submitted March 11, 2015; date of first revision March 16, 2015; accepted for publication March 11, 2015; online publication April 18, 2015. doi:10.1093/ajh/hpv046 © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: [email protected]
lacking, the possibility of volume contraction is real—particularly if diuretic and angiotensin blockade are part of the therapy in patients adhering to a sodiumrestricted diet. The consequences described here are modest. However, evidence exists that blockade of both the volume and vasoconstriction supports of blood pressure can be associated with increased mortality in studies of persons with established cardiovascular disease.2 Patients at risk have high plasma renin activity (PRA), lower blood pressure, elevated blood urea nitrogen, and uric acid, compared to lower risk participants in the same studies. Elevated PRA is a protective response to maintain blood pressure, particularly in patients receiving both diuretic and renin-angiotensin-system blocking agents. In such patients, liberalization of sodium intake and reduction of naturetic drugs, sufficient to moderate
PRA while maintaining adequate blood pressure, may be of benefit.
DISCLOSURE
The author declared no conflict of interest.
REFERENCES 1. Katz LA. Hazard of Low Salt Intake. Am J Hypertens 2015; e-pub ahead of print 20 March 2015. 2. Sealey JE, Alderman MH, Furberg CD, Laragh JH. Renin-angiotensin system blockers may create more risk than reward for sodiumdepleted cardiovascular patients with high plasma renin levels. Am J Hypertens 2013; 26:727–738.
American Journal of Hypertension 28(7) July 2015 953
Downloaded from http://ajh.oxfordjournals.org/ at The Chinese University of Hong Kong on March 18, 2016
To the Editor: Professor Katz has reminded us that vascular fragility is a common hazard of age that can sometimes be relieved by volume expansion.1 Of interest in his cases is the coincidence of sodium-restricted diet and antihypertensive medication. Although details are
Response to “Hazard of Low Salt Intake” Michael H. Alderman1
Correspondence: Michael H. Alderman ([email protected]). 1Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
Initially submitted March 11, 2015; date of first revision March 16, 2015; accepted for publication March 11, 2015; online publication April 18, 2015. doi:10.1093/ajh/hpv046 © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: [email protected]
lacking, the possibility of volume contraction is real—particularly if diuretic and angiotensin blockade are part of the therapy in patients adhering to a sodiumrestricted diet. The consequences described here are modest. However, evidence exists that blockade of both the volume and vasoconstriction supports of blood pressure can be associated with increased mortality in studies of persons with established cardiovascular disease.2 Patients at risk have high plasma renin activity (PRA), lower blood pressure, elevated blood urea nitrogen, and uric acid, compared to lower risk participants in the same studies. Elevated PRA is a protective response to maintain blood pressure, particularly in patients receiving both diuretic and renin-angiotensin-system blocking agents. In such patients, liberalization of sodium intake and reduction of naturetic drugs, sufficient to moderate
PRA while maintaining adequate blood pressure, may be of benefit.
DISCLOSURE
The author declared no conflict of interest.
REFERENCES 1. Katz LA. Hazard of Low Salt Intake. Am J Hypertens 2015; e-pub ahead of print 20 March 2015. 2. Sealey JE, Alderman MH, Furberg CD, Laragh JH. Renin-angiotensin system blockers may create more risk than reward for sodiumdepleted cardiovascular patients with high plasma renin levels. Am J Hypertens 2013; 26:727–738.
American Journal of Hypertension 28(7) July 2015 953
Downloaded from http://ajh.oxfordjournals.org/ at The Chinese University of Hong Kong on March 18, 2016
To the Editor: Professor Katz has reminded us that vascular fragility is a common hazard of age that can sometimes be relieved by volume expansion.1 Of interest in his cases is the coincidence of sodium-restricted diet and antihypertensive medication. Although details are
