Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial
Background. Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. Objectives. Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in ide...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | International Journal of Hypertension |
| Online Access: | http://dx.doi.org/10.1155/2018/7437858 |
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| author | Andrea Pio-Abreu Isac de Castro Giovanio Vieira da Silva Katia Coelho Ortega Decio Mion |
| author_facet | Andrea Pio-Abreu Isac de Castro Giovanio Vieira da Silva Katia Coelho Ortega Decio Mion |
| author_sort | Andrea Pio-Abreu |
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| description | Background. Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. Objectives. Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in identifying salt-sensitive patients. Methodology. We conducted a randomized crossover study with 30 hypertensive individuals comprising the following steps: (1) washout; (2) phase A (low- and high-sodium diet cycles); (3) washout 2; (4) phase B (fludrocortisone test). Phase A and B steps were performed in a random way. Consistent with the literature, we found that 53.3% were salt-sensitive according to the reference test. Using the ROC curve, the fludrocortisone test defined salt sensitivity by a median blood pressure increase of ≥3 mmHg. A good accuracy of fludrocortisone in detecting salt sensitivity was observed (AUC: 0.732±0.065; p<0.001), with 80% sensitivity and 53% specificity. Conclusion. The fludrocortisone test is a good option for screening salt sensitivity in hypertensive patients. However, the low specificity prevents this test from being an ideal substitute to the labor-intensive diet cycles exam in the definition of salt sensitivity. This clinical trial is registered with NCT01453959. |
| format | Article |
| id | doaj-art-c6816708324d4d33bdd84229b87da408 |
| institution | Kabale University |
| issn | 2090-0384 2090-0392 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Hypertension |
| spelling | doaj-art-c6816708324d4d33bdd84229b87da4082025-02-03T01:30:56ZengWileyInternational Journal of Hypertension2090-03842090-03922018-01-01201810.1155/2018/74378587437858Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover TrialAndrea Pio-Abreu0Isac de Castro1Giovanio Vieira da Silva2Katia Coelho Ortega3Decio Mion4Hypertension Unit, Renal Division of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, BrazilRenal Division of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, BrazilHypertension Unit, Renal Division of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, BrazilHypertension Unit, Renal Division of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, BrazilHypertension Unit, Renal Division of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, BrazilBackground. Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. Objectives. Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in identifying salt-sensitive patients. Methodology. We conducted a randomized crossover study with 30 hypertensive individuals comprising the following steps: (1) washout; (2) phase A (low- and high-sodium diet cycles); (3) washout 2; (4) phase B (fludrocortisone test). Phase A and B steps were performed in a random way. Consistent with the literature, we found that 53.3% were salt-sensitive according to the reference test. Using the ROC curve, the fludrocortisone test defined salt sensitivity by a median blood pressure increase of ≥3 mmHg. A good accuracy of fludrocortisone in detecting salt sensitivity was observed (AUC: 0.732±0.065; p<0.001), with 80% sensitivity and 53% specificity. Conclusion. The fludrocortisone test is a good option for screening salt sensitivity in hypertensive patients. However, the low specificity prevents this test from being an ideal substitute to the labor-intensive diet cycles exam in the definition of salt sensitivity. This clinical trial is registered with NCT01453959.http://dx.doi.org/10.1155/2018/7437858 |
| spellingShingle | Andrea Pio-Abreu Isac de Castro Giovanio Vieira da Silva Katia Coelho Ortega Decio Mion Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial International Journal of Hypertension |
| title | Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial |
| title_full | Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial |
| title_fullStr | Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial |
| title_full_unstemmed | Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial |
| title_short | Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial |
| title_sort | oral fludrocortisone test for salt sensitive screening in hypertensive patients a randomized crossover trial |
| url | http://dx.doi.org/10.1155/2018/7437858 |
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