There’s clear data that salt is associated with the development of hypertension in healthy populations. Recently, a small randomized crossover study examined the role of salt sensitivity in resistant hypertension. Participants followed two 7-day diets: a low-sodium diet (50 mmol/day) and a high-sodium diet (250 mmol/day), separated by a 2-week washout period. During the low-salt diet, mean systolic and diastolic blood pressures were lowered by 22.7 mm Hg and 9.1 mm Hg, respectively (Hypertension 2009 Sep;54:475).

I’ve learned from my nephrology colleagues how hypertension control in difficult patients can be improved by optimally treating volume status (i.e. in a patient with significant volume overload, especially those with renal dysfunction, more aggressive diuresis will help reach BP targets). Another clinical pearl from one of our local nephrologists is that giving Lasix 20 mg 3X per week helps eliminate salt and may help BP control in those who can’t adequately lower their sodium intake. Lifestyle changes such as weight reduction and low-salt diet should never be ignored in the management of hypertension. The challenge is getting patients to buy in to this approach.

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