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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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Autores principales: Pio-Abreu, Andrea, de Castro, Isac, da Silva, Giovanio Vieira, Ortega, Katia Coelho, Mion, Decio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276467/
https://www.ncbi.nlm.nih.gov/pubmed/30581606
http://dx.doi.org/10.1155/2018/7437858
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author Pio-Abreu, Andrea
de Castro, Isac
da Silva, Giovanio Vieira
Ortega, Katia Coelho
Mion, Decio
author_facet Pio-Abreu, Andrea
de Castro, Isac
da Silva, Giovanio Vieira
Ortega, Katia Coelho
Mion, Decio
author_sort Pio-Abreu, Andrea
collection PubMed
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.
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spelling pubmed-62764672018-12-23 Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial Pio-Abreu, Andrea de Castro, Isac da Silva, Giovanio Vieira Ortega, Katia Coelho Mion, Decio Int J Hypertens Clinical Study 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. Hindawi 2018-11-15 /pmc/articles/PMC6276467/ /pubmed/30581606 http://dx.doi.org/10.1155/2018/7437858 Text en Copyright © 2018 Andrea Pio-Abreu et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Pio-Abreu, Andrea
de Castro, Isac
da Silva, Giovanio Vieira
Ortega, Katia Coelho
Mion, Decio
Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial
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
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276467/
https://www.ncbi.nlm.nih.gov/pubmed/30581606
http://dx.doi.org/10.1155/2018/7437858
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