Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

In a small randomized crossover study, a low-salt diet had dramatic effects on blood pressure.

Patients with resistant hypertension — elevated blood pressure that persists despite the use of three or more antihypertensive agents — are frequently encountered in clinical practice. To examine the role of salt sensitivity in resistant hypertension, investigators conducted a randomized crossover evaluation of two 7-day diets, one low-sodium (50 mmol/day) and one high-sodium (250 mmol/day), separated by a 2-week washout period. Twelve adults (mean age, 56; 8 women; 6 black patients) completed the study. At baseline, participants were taking an average of 3.4 antihypertensive medications, and the mean office blood pressure was 145.8/83.9 mm Hg. All participants continued taking their medications during the study.

Mean urinary sodium excretion during the low-salt diet was significantly lower than during the high-salt diet, indicating adherence to the dietary salt intake regimen. Compared with the high-salt diet, mean office systolic and diastolic blood pressures were lower by 22.7 mm Hg and 9.1 mm Hg, respectively, during the low-salt diet. After adjustment for multiple testing, the between-diet differences in office systolic blood pressure and in all 24-hour ambulatory blood pressure measurements remained significant.

Comment: According to this small study, excessive dietary sodium intake is an important contributor to resistant hypertension. We are well reminded that ensuring a reduction in sodium ingestion is a crucial component in the care of hypertensive patients.

— Joel M. Gore, MD

Published in Journal Watch Cardiology September 23, 2009

Citation:
Pimenta E et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial. Hypertension 2009 Sep; 54:475. [Medline® Abstract] [Free full-text article pdf]

Copyright © 2009. Massachusetts Medical Society. All rights reserved.

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