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The role of salt in hypertension: the complexity seems to become clearer

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 2–3 (2008)Cite this article

In an early issue of this journal, Varagic and I discussed a major conundrum relating to hypertension: the strong epidemiological relationship between salt and the prevalence of hypertension in populations, despite the relatively infrequent occurrence of pressure elevation when patients with essential hypertension are salt-loaded (i.e. salt sensitivity).1 In that Review we provided our recent data demonstrating that when genetically hypertensive rats were chronically salt-loaded, their already elevated arterial pressure increased only slightly, but significantly. Interestingly, these rats also demonstrated profound cardiac, aortic and renal functional changes—alterations commonly seen in patients with essential hypertension who have target-organ involvement.

I believe that the role of salt in hypertension is far more complex than concluded from earlier epidemiological studies (i.e. that it 'simply' raises arterial pressure), and posit that long-term salt loading exacerbates adverse structural and functional target-organ changes, independent of its effect on arterial pressure. In this Viewpoint, I present evidence that prolonged dietary salt surfeit subtly and significantly intensifies the overall hypertensive disease process over and above its pressure elevation effect. Varagic and my earlier report emphasized that the close epidemiological relationship between excessive salt intake and prevalence of essential hypertension involved only a minority of patients—those who are 'salt sensitive' (defined as a significant increase in arterial pressure with salt loading).1 As a backdrop to this controversial area, the incidences of cardiac failure, reduced large artery distensibility, end-stage renal disease, and isolated systolic hypertension, continue to increase unabatedly, even though deaths from stroke and coronary heart disease have diminished by more than 70% and 54%, respectively.2,3

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  1. Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA efrohlich@ochsner.org

Authors and Affiliations

  1. ED Frohlich is the Alton Ochsner Distinguished Scientist at the Ochsner Clinic Foundation, New Orleans, LA, USA.,

    Edward D Frohlich

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Frohlich ED and Varagic J (2004) The role of sodium in hypertension is more complex than simply elevating arterial pressure. Nat Clin Pract Cardiovasc Med 1: 24–30

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Frohlich, E. The role of salt in hypertension: the complexity seems to become clearer. Nat Rev Cardiol 5, 2–3 (2008). https://doi.org/10.1038/ncpcardio1087

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