Treating Salt-Sensitive Hypertension: Antihypertensive Classes Compared

SSH is an intermediate inherited phenotype of essential hypertension
SSH is an intermediate inherited phenotype of essential hypertension

Combining a calcium-channel blocker (CCB) with hydrochlorothiazide (HCTZ) and moderate salt intake may be best for reducing blood pressure in patients with salt-sensitive hypertension (SSH), according to a study published in the American Journal of Hypertension

For this study, researchers aimed to compare the effectiveness of various antihypertensive drug classes combined with salt intake on the reduction of blood pressure in patients with SSH. They searched various databases from inception to November 2016 for studies that compared 2 or more antihypertensive agents or placebos in adults with SSH. Clinical outcomes included changes in mean arterial blood pressure, systolic and diastolic blood pressure. 

A total of 25 studies were identified for the meta-analysis. The results showed for SSH patients with no comorbidities, CCB + HCTZ with moderate salt intake was most effective compared with placebo (standardized mean differences [SMD] 26.66, 95% CI: 12.60–40.16), angiotensin II receptor blockers (ARBs) (SMD 22.94, 95% CI: 5.26–40.51), and other interventions (angiotensin converting enzyme inhibitors, clonidine). 

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For obese adults with SSH, combining a CCB with metformin and moderate salt intake proved most efficacious (SMD 17.90, 95% CI: 6.26–29.33). 

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