Salt, Not Always a Cardiovascular Enemy? A Mini-Review and Modern Perspective

Abstract

Dietary salt intake is a long-debated issue. Increased sodium intake is associated with high blood pressure, leading to salt-sensitive hypertension. Excessive salt intake leads to arterial stiffness in susceptible individuals via impaired nitric oxide action and increased endothelin-1 expression, overactivity of the renal sympathetic nervous system and also via aldosterone-independent activation of the mineralocorticoid receptor. Salt restriction in such individuals reduces blood pressure (BP) values. The optimal level of salt restriction that leads to improved cardiovascular outcomes is still under debate. Current BP and dietary guidelines recommend low sodium intake for the general population. However, a specific category of patients does not develop arterial hypertension in response to sodium loading. In addition, recent research demonstrates the deleterious effects of aggressive sodium restriction, even in heart failure patients. This mini review discusses current literature data regarding the advantages and disadvantages of salt restriction and how it impacts the overall health status.

Keywords: salt; salt restriction; salt-sensitive hypertension.

Figure 1

Development of salt-sensitive hypertension and various consequences of salt restriction. BP = blood pressure, CVD = cardiovascular disease, MR = mineralocorticoid receptor, Na = sodium, NO = nitric oxide, SNS = sympathetic nervous system.