Impact of Light Salt Substitution for Regular Salt on Blood Pressure of Hypertensive Patients / Impacto da Substituição de Sal Comum por Sal Light sobre a Pressão Arterial de Pacientes Hipertensos

Background: Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients. Objective: To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients. Methods: Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks. Results: The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032). Conclusions: The light salt substitution for regular salt significantly reduced BP of hypertensive patients. .

Fundamento: Alguns estudos demostraram um efeito benéfico da restrição de sódio na pressão arterial (PA) de hipertensos. Objetivo: Avaliar o impacto da substituição do sal comum por sal light na PA de hipertensos. Métodos: Hipertensos não controlados, de ambos os sexos, com idades entre 20 e 65 anos, e usando doses estáveis de anti-hipertensivos foram randomizados para um Grupo Intervenção (GI - recebendo sal light) e um Grupo Controle (GC - recebendo sal comum). A PA sistólica (PAS) e a PA diastólica (PAD) foram analisadas usando-se medidas casuais da PA e Monitoração Residencial da Pressão Arterial (MRPA), e a excreção de sódio e potássio foi avaliada em amostras de urina de 24 horas. Os pacientes receberam 3 g de sal para consumo diário por 4 semanas. Resultados: Este estudo avaliou 35 pacientes (65,7% mulheres), 19 alocados no GI e 16 no GC. A idade média foi de 55,5 ± 7,4 anos. A maioria dos participantes havia completado o ensino fundamental (até a 8a série; n = 28; 80,0%), tinha renda familiar de até dois salários mínimos (n = 17; 48,6%) e praticava atividade física regularmente (n = 19; 54,3%). Dois pacientes (5,7%) eram fumantes e 40,0% consumiam álcool com regularidade (n = 14). O GI mostrou uma significativa redução tanto da PAS quanto da PAD nas medidas casuais e de MRPA (p < 0,05) e, ainda, diminuição da excreção de sódio (p = 0,016). O GC apresentou redução significativa apenas na medida casual da PAS (p = 0,032). Conclusões: A substituição do sal comum por sal light diminuiu significativamente a PA de hipertensos. .

Impact of light salt substitution for regular salt on blood pressure of hypertensive patients.

BACKGROUND: Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients. OBJECTIVE: To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients. METHODS: Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks. RESULTS: The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032). CONCLUSIONS: The light salt substitution for regular salt significantly reduced BP of hypertensive patients.

Epidemiologia e orientações para o tratamento não farmacológico e farmacológico da hipertensão arterial em idosos / Epidemiology and guidelines for the non-pharmacological and pharmacological treatment of hypertension in the elderly

A prevalência de hipertensão arterial (HAS) na faixa etária acima dos 65 anos é maior que 60%. Estima-se que nos Estados Unidos 69% dos pacientes com antecedente de infarto agudo do miocárdio, 77% com antecedente de acidente vascular cerebral e 74% com histórico de insuficiência cardíaca tenham diagnóstico prévio de HAS. Existem evidências consistentes suportando a recomendação para o tratamento em pacientes com mais de 60 anos de idade, com redução na incidência de desfechos cardiovasculares, mas persistem dúvidas em relação aos que ultrapassam 80 anos. Recentemente, a publicação do National Institute for Health and Clinical Excellence para o tratamento da HAS em adultos recomendou a prescrição de drogas antihipertensivas em pacientes idosos com menos de 80 anos e hipertensão estágio 1 na presença de lesão em órgão-alvo, doença cardiovascular estabelecida, doença renal, diabetes ou risco cardiovascular em 10 anos ≥ 20%. Para quem tinha mais que 80 anos, a recomendação foi de tratamento medicamentoso a partir do estágio 2. A escolha da classe do anti-hipertensivo e a dose inicial devem levar em conta o risco de hipotensão postural bem como as comorbidades associadas. Idealmente devemos começar com doses mais baixas que as utilizadas para a população geral, aumentá-la de maneira gradual e em intervalos mais prolongados ou associar uma segunda classe também em doses inferiores, caso as metas não tenham sido atingidas. Apesar dos evidentes benefícios do tratamento, ainda há dúvidas em relação aos valores de pressão arterial que devem ser alcançados como meta.

The preponderance of hypertension (HTN) in the age group over 65 is greater than 60%. The estimate is that, in the United States, 69% of patients with previous myocardial infarction, 77% with a history of stroke and 74% with a history of heart failure had a previous diagnosis of HTN. There is consistent evidence supporting the recommendation for treatment in patients aged more than 60 years old, with reduction in the incidence of cardiovascular outcomes, however, doubt remains regarding the ones over 80. Recently, the publication of the National Institute for Health and Clinical Excellence for the treatment of HTN in adults recommended the prescription of the antihypertensive drugs in elderly patients under 80 years old and stage 1 hypertension in the presence of target-organ damage, established cardiovascular disease, kidney disease, diabetes or cardiovascular risk in 10 years ≥ 20%. For those who were over 80, medical treatment from stage 2 was recommended. The choice of the class of antihypertensive and initial dose should take into account the risk of orthostatic hypotension and the associated comorbidities. Ideally we should start with lower doses than those used for the general population, increasing it gradually at longer intervals or associate a second class also at lower doses, if the goals have not been achieved. Despite the perceptible benefits of treatment, there are still questions regarding blood pressure that must be achieved as a goal.