Low-sodium diets reduce blood pressure in hypertensives by around 5 – 6 mmHg (around 10 in Asians). However, they increase cholesterol by around 2.5%, and long-term health effects are unknown.
Interesting editorial about the recent BMJ meta-analysis of intensive vs. normal glucose control in Type 2 diabetes. It seems that a recent Cochrane review found a reduced risk of nephropathy, amputation, and retinal photocoagulation with more intensive control. So why the difference? As I suspected, a lot of it is because some of the larger trials were in fact comparing extremely strict control with strict control. Another issue, however, which I hadn’t been aware of, is that the benefits only show up several years later. The UKPDS trial showed that good control in the early years post-diagnosis improves outcomes long-term even if control is then similar in the years thereafter. The editorial’s conclusion was that we should aim for targets of around 7.0 – 7.5%, no lower than 7%, and that early control is important.
On the same lines, intensive control in Type 1 diabetes in the early years halves the long-term risk of renal impairment, according to the latest follow-up from the DCCT trial.