Estimation of Salt Intake and its Relation to Knowledge and Attitude Regarding the Dangers of High Salt Intake among an Urban Omani Population: A pilot study.

Objectives: High salt consumption is a major risk factor for hypertension. Studies have shown dietary salt intake to be high in many parts of the world. This study aimed to assess the daily salt consumption of the Omani urban population and their knowledge and attitudes regarding dietary salt. Methods: This cross-sectional questionnaire-based study was conducted in Muscat between September and December 2017. Participants were recruited from malls, university students and staff, hospital staff and their relatives and relatives of patients. A previously validated questionnaires were used to assess the participants' salt intake and their knowledge and attitudes regarding salt intake. Results: A total of 345 participants were included in this study (response rate: 69%), of which 300 responses (mean age: 27.88 ± 7.9 years, 54.3% male) were included for analysis. Overall, 94.3% of the participants agreed that lowering salt in diet is important, and nearly half the participants said that they were taking measures to reduce salt intake. However, the median salt intake was high at 10.5 g/day (interquartile range: 7.3-15.1 g/day), with 90% of the respondents consuming more than the maximum recommended amount of salt per day. Salt intake was significantly higher in women and the older age group (>40 years). There did not appear to be any correlation between awareness of the dangers of salt intake and the amount consumed. Conclusion: The salt intake in the sampled population in Oman was high and did not depend on knowledge. Strategies should be designed to reduce salt intake among the urban population, including health education to increase knowledge about the complications of high salt intake.

Cardiovascular Manifestations and Outcomes in Patients Admitted with Severe COVID-19: Middle Eastern Country Multicenter Data.

OBJECTIVES: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) -that can affect the cardiovascular system. The aim of our study was to assess the cardiovascular manifestations and its effect on the overall mortality among patients with severe COVID-19 who were admitted in the intensive care units (ICU). METHODS: This is a retrospective, multicenter cohort study that included all adult patients admitted to the ICU with laboratory-confirmed COVID-19 in three major hospitals in Oman between March 1, 2020, and August 10, 2020. RESULTS: A total of 541 patients (mean age of 50.57 ± 15.57 years; 401 [74.1%] male) were included in the study of which 452 (83.5%) were discharged and 89 (16.5%) died during hospitalization.Evidence of cardiac involvement was found in 185 (34.2%) patients, which included raised troponin (31.6%), arrhythmias (4.3%), myocardial infarctions (2.6%), or drop in ejection fraction (0.9%). High troponin of >100 ng/l was associated with higher mortality (odds ratio [OR] = 7.98; 95% confidence interval [CI]: 4.20-15.15); P < 0.001). Patients with any cardiovascular involvement also had a high risk of dying (OR = 8.8; 95% CI: 4.6-16.5; P < 0.001). CONCLUSION: Almost a third of patients in our study had evidence of cardiovascular involvement which was mainly myocardial injury. This was associated with increased mortality.

Does the ratio of serum aldosterone to plasma renin activity predict the efficacy of diuretics in hypertension? Results of RENALDO.

OBJECTIVES: We hypothesized that the aldosterone: renin ratio (ARR) predicts the antihypertensive response to mineralocorticoid receptor antagonist, spironolactone (SPIRO), when compared with bendroflumethiazide (BFZ). METHODS: We conducted a randomized, crossover, trial on hypertensive patients with either high ARR (HARR defined as >750 and plasma aldosterone >250 pmol/l) or low ARR (LARR defined as <300 and plasma renin activity <10 ng/ml per h). Each group took SPIRO 50 mg once daily for 12 weeks and BFZ 2.5 mg once daily for 12 weeks in random order separated by 2-week washout. Patients with mean 24-h systolic ambulatory blood pressure (SABP) at least 140 mmHg were included. Primary endpoint was difference in SABP between SPIRO and BFZ in patients with HARR compared with those with LARR. RESULTS: One hundred and eleven patients (60 HARR and 51 LARR) completed the study. SABP at 12 weeks in the HARR group was 129.4 mmHg on SPIRO and 134.4 mmHg on BFZ [difference -5.01; 95% confidence interval (CI) -7.51, -2.52; P < 0.0002]. In the LARR group, SABP was 129.7 mmHg on SPIRO and 133.1 mmHg on BFZ [difference -3.43 (95% CI -6.18, -0.68) P < 0.01]. Difference between groups (HARR vs. LARR) was -1.58 mmHg (95% CI 5.25, -2.08; not significant, P = 0.394). In a secondary analysis of the overall study population of 111 patients, SABP reduction with SPIRO 50 mg was superior to BFZ 2.5 mg [SPIRO -14.8 mmHg, BFZ -10.5 mmHg, difference -4.29 mmHg (95% CI -6.12, -2.46)]. Results were similar for secondary endpoints. Plasma renin activity or aldosterone did not predict blood pressure response to SPIRO. Results were independent of concomitant angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. CONCLUSION: The ARR did not predict the blood pressure response to SPIRO. SPIRO 50 mg was significantly more effective than BFZ 2.5 mg in lowering SABP irrespective of baseline ARR, plasma renin activity or aldosterone.

Does the aldosterone:renin ratio predict the efficacy of spironolactone over bendroflumethiazide in hypertension? A clinical trial protocol for RENALDO (RENin-ALDOsterone) study.

BACKGROUND: High blood pressure is an important determinant of cardiovascular disease risk. Treated hypertensives do not attain a risk level equivalent to normotensives. This may be a consequence of suboptimal blood pressure control to which indiscriminate use of antihypertensive drugs may contribute. Indeed the recent ALLHAT1study suggests that thiazides should be given first to virtually all hypertensives. Whether this is correct or whether different antihypertensive therapies should be targeted towards different patients is a major unresolved issue, which we address in this study. The measurement of the ratio of aldosterone: renin is used to identify hypertensive subjects who may respond well to treatment with the aldosterone antagonist spironolactone. It is not known if subjects with a high ratio have aldosteronism or aldosterone-sensitive hypertension is debated but it is important to know whether spironolactone is superior to other diuretics such as bendroflumethiazide in this setting. METHODS/DESIGN: The study is a double-blind, randomised, crossover, controlled trial that will randomise 120 hypertensive subjects to 12 weeks treatment with spironolactone 50 mg once daily and 12 weeks treatment with bendroflumethiazide 2.5 mg once daily. The 2 treatment periods are separated by a 2-week washout period. Randomisation is stratified by aldosterone: renin ratio to include equal numbers of subjects with high and low aldosterone: renin ratios. Primary Objective--To test the hypothesis that the aldosterone: renin ratio predicts the antihypertensive response to spironolactone, specifically that the effect of spironolactone 50 mg is greater than that of bendroflumethiazide 2.5 mg in hypertensive subjects with high aldosterone: renin ratios. Secondary Objectives--To determine whether bendroflumethiazide induces adverse metabolic abnormalities, especially in subjects with high aldosterone: renin ratios and if baseline renin measurement predicts the antihypertensive response to spironolactone and/or bendrofluazide. DISCUSSION: The numerous deleterious effects of hypertension dictate the need for a systematic approach for its treatment. In spite of various therapies, resistant hypertension is widely prevalent. Among various factors, primary aldosteronism is an important cause of resistant hypertension and is now more commonly recognised. More significantly, hypertensives with primary aldosteronism are also exposed to various other deleterious effects of excess aldosterone. Hence treating hypertension with specific aldosterone antagonists may be a better approach in this group of patients. It may lead on to better blood pressures with fewer medications.