Nephro Trial Files Throwback Thursday: Salt Substitution, Indapamide for HTN, and BP Control in T2DM
Effect of Salt Substitution on Cardiovascular Events and Death
Neal B et al. NEJM (August 2021)
Bottom Line: This open-label, cluster-randomized trial involving 20,995 persons from 600 villages in rural China compared the effects of a salt substitute (75% sodium chloride and 25% potassium chloride by mass) to regular salt (100% sodium chloride) on stroke, major adverse cardiovascular events, and death from any cause in individuals with a history of stroke or aged 60 years or older with high blood pressure. The intervention group had a lower rate of stroke (29.14 events per 1000 person-years) compared to the control group (33.65 events per 1000 person-years) over a mean duration of 4.74 years. The rates of major cardiovascular events and death were also lower in the intervention group. There was no significant difference in rates of serious adverse events attributed to hyperkalemia between the two groups.
Treatment of Hypertension in Patients 80 Years of Age or Older
Beckett NS et al. NEJM (May 2008)
Bottom Line: This randomized controlled trial, conducted in Europe, China, Australasia, and Tunisia, evaluated the effectiveness of antihypertensive therapy in patients 80 years of age or older with a sustained systolic blood pressure of 160 mm Hg or more. The intervention group received indapamide (sustained release, 1.5 mg) with possible addition of perindopril (2 or 4 mg), while the comparator group received placebo. The primary outcome, fatal or nonfatal stroke, was significantly reduced in the intervention group compared to the control group. Additionally, the intervention group had lower rates of death from stroke, death from any cause, death from cardiovascular causes, and heart failure. Fewer serious adverse events were reported in the intervention group. This study provides evidence that antihypertensive treatment in this patient population is beneficial.
Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus
ACCORD Study Group. NEJM (April 2010)
Bottom Line: This randomized controlled trial investigated the effects of intensive therapy targeting a systolic pressure of less than 120 mm Hg compared to standard therapy targeting a systolic pressure of less than 140 mm Hg in 4733 participants with type 2 diabetes at high risk for cardiovascular events. After 4.7 years, there was no significant difference in the primary outcome of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes between the two groups. However, the intensive-therapy group did have a lower rate of stroke. Serious adverse events attributed to antihypertensive treatment were more common in the intensive-therapy group. This study suggests that targeting a systolic blood pressure of less than 120 mm Hg may not be beneficial in this patient population.
Nephro Trial Files Issue #NPH-2025-13
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