EFFECTS OF MODERATE SALT RESTRICTION ALONE AND IN COMBINATION WITH CILAZAPRIL ON OFFICE AND AMBULATORY BLOOD-PRESSURE

The purpose of the present study was to examine the effects of salt-re striction alone and in combination with an angiotensin-converting enzy me (ACE) inhibitor (cilazapril) on both office and ambulatory blood pr essure (BP) levels in free living subjects with elevated BP. The study was carried out in an out-patient setting with subjects recruited fro m occupational health care system mainly. After exclusions, 39 subject s (24 men, 15 women, aged 28-65 years) with mildly to moderately eleva ted BP completed the study. After 3 months run-in period with placebo (first month on normal-salt and the next 2 months on sodium-restricted diet) the subjects were randomised into either salt-restriction place bo or salt-restriction cilazapril (2.5 mg daily) groups for 3 months. In the whole group, 24-h urinary sodium excretion decreased (mean+/-s. d.) from 198+/-60 to 112+/- 59 mmol (4 weeks vs 24 weeks, P <0.001). S ystolic and diastolic office BP decreased during the placebo-sodium-re striction phase (-7.1 [95% CI-11.2; -3.0] and -4.2 [95% Cl-6.6; -1.8] mm Hg for systolic and diastolic BP), and similarly the daytime ambula tory BP (ABP) was reduced during this period (-2.8 [95% CI-5.2; -0.5] and -2.8 [95% CI-4.5; -1.2] mm Hg, systolic (SBP) and diastolic blood pressure (DBP) respectively). No changes were observed in the night ti me ABP. Addition of cilazapril to sodium-restriction enhanced signific antly the office BP (-13.2, [95% CI-20.2; -6.2], and -9.1 [95% CI-13.5 ; -4.7]) and daytime ABP (-5.9, [95% CI-10.1; -1.8] and -5.3, [95% CI- 8.8; -1.9]) reduction. Blood glucose, plasma insulin or serum lipids d id not change during the study, Moderate sodium restriction seems to l ower the office and daytime ABP levels in subjects with mild-to-modera te hypertension. The antihypertensive effect of cilazapril could be en hanced by sodium restriction.