[Salt sensitivity and hypertension]

Abstract

For many years there has been ongoing controversy concerning the presumed relationship between salt intake and population blood pressure. In addition, in light of the availability of many efficient antihypertensive drugs and the frequent difficulty to motivate patients to maintain prolonged salt restriction, clinicians often doubt the importance of salt restriction in the individual treatment of hypertension. Accumulating data now underline the importance of a restriction of salt intake on a population level. This is expressed in a recent advice of the Dutch Health Council (Gezondheidsraad) and governmental intervention in some other countries. However, it is not the level of salt intake but salt sensitivity of blood pressure which predicts the effect of salt restriction in the individual treatment of essential hypertension. It should be noted that salt restriction or depletion will increase the sensitivity to other antihypertensive drugs in each form of hypertension. Recent data suggest that salt sensitivity per se should be viewed as an independent risk factor for cardiovascular morbidity and mortality. Therefore, identification and aggressive treatment of salt-sensitive hypertension, including salt restriction, is indicated. Demographic and racial characteristics as well as additional laboratory investigation may help identifying potential 'salt-sensitive' subjects, who form part of a high-risk population.