Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group.

The Modification of Diet in Renal Disease Study showed a beneficial effect of a lower-than-usual blood pressure (BP) goal on the progression of renal disease in patients with proteinuria. The purpose of the present analyses was to examine the achieved BP, baseline characteristics that helped or hindered achievement of the BP goals, and safety of the BP interventions. Five hundred eighty-five patients with baseline glomerular filtration rate between 13 and 55 mL/min per 1.73 m2 (0.22 to 0.92 mL/s per 1.73 m2) were randomly assigned to either a usual or low BP goal (mean arterial pressure < or = 107 or < or = 92 mm Hg, respectively). Few patients had a history of cardiovascular disease. All antihypertensive agents were permitted, but angiotensin-converting enzyme inhibitors (with or without diuretics) followed by calcium channel blockers were preferred. The mean (+/- SD) of the mean arterial pressures during follow-up in the low and usual BP groups was 93.0 +/- 7.3 and 97.7 +/- 7.7 mm Hg, respectively. Follow-up BP was significantly higher in subgroups of patients with preexisting hypertension, baseline mean arterial pressure > 92 mm Hg, a diagnosis of polycystic kidney disease or glomerular diseases, baseline urinary protein excretion > 1 g/d, age > or = 61 years, and black race. The frequency of medication changes and incidence of symptoms of low BP were greater in the low BP group, but there were no significant differences between BP groups in stop points, hospitalizations, or death. When data from both groups were combined, each 1-mm Hg increase in follow-up systolic BP was associated with a 1.35-times greater risk of hospitalization for cardiovascular or cerebrovascular disease. Lower BP than usually recommended for the prevention of cardiovascular disease is achievable by several medication regimens without serious adverse effects in patients with chronic renal disease without cardiovascular disease. For patients with urinary protein excretion > 1 g/d, target BP should be a mean arterial pressure of < or = 92 mm Hg, equivalent to 125/75 mm Hg.

The effects of dieting on plasma tryptophan concentration and food intake in healthy women.

Although many people diet, relatively few dieters are successful in maintaining weight loss. The extent to which dieting behavior might dampen satiety responses normally mediated by the neurotransmitter serotonin remains uncertain. This study tested the hypothesis that dieting behavior decreases the availability of plasma tryptophan (TRP) and the ratio of TRP to other branched-chain amino acids (BCAA) that compete for entry into the central nervous system (CNS). This effect could diminish the CNS concentration of TRP, the amino acid precursor for serotonin synthesis, thus interfering with serotonin-mediated influences on food intake. Using a fixed-order design, 15 healthy, normal-weight women were studied longitudinally during an ad lib dietary intake phase and subsequent reduced-calorie diet phase. Physiological and behavioral measures were collected at baseline, at the end of the ad lib-intake phase, and at the end of the 4-week study diet phase. Food intake was measured by a single-item test meal. Plasma TRP and TRP: sigma BCAA significantly decreased following the study diet compared to baseline (p < 0.05). Change in TRP and TRP: sigma BCAA significantly correlated with decrease in body weight (p < 0.01). No significant relationship was observed between postdiet change in TRP or TRP: sigma BCAA ratio and postdiet change in test meal food intake, with covariation for weight loss. The observed decreases in plasma TRP and TRP: sigma BCAA extend previous reports suggesting that dieting behavior may diminish central serotonin function through a reduction in precursor availability.