Salt and Hypertension Hypothesis - Still Relevant

Abstract

Dietary salt intake is a common and important risk factor for hypertension. There has been a shift in the understanding of the pathogenesis of hypertension and the role that salt plays in its development -from the centrality of kidney, to the concept of salt sensitivity and more lately, hypertension as a disorder of endothelial function. There remains much heated debate and controversy about the relation between salt and hypertension, with both proponents and opponents pointing to observational, experimental, and epidemiological evidence supporting their claims. Other dietary factors such as refined sugars and potassium have also been identified as important contributory factors to hypertension, raising the question of whether the role of salt was as central as it was purported to be. While few would challenge the evidence showing the benefit of a low-salt diet in hypertensive patients, the contention is whether the same strategy of salt restriction should apply to normotensive populations to prevent hypertension, given observational data that low-salt intake may be associated with increased cardiovascular risk. With increasing prevalence of hypertension and burden of metabolic diseases worldwide, more evidence in the form of randomized controlled trials is required to determine whether a lowsalt intake should be recommended as policy, which must strive to benefit majority of the population without causing harm to the minority. Until then, the salt and hypertension hypothesis is likely to remain relevant in the foreseeable future.