Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant Hypertension: Results From a Randomized Trial
Open accessAbstract
Observational studies indicate a significant relation between dietary sodium and level of blood pressure. However, the role of salt sensitivity in the development of resistant hypertension is unknown. The present study examined the effects of dietary salt restriction on office and 24-hour ambulatory blood pressure in subjects with resistant hypertension. Twelve subjects with resistant hypertension entered into a randomized crossover evaluation of low (50 mmol/24 hours×7 days) and high sodium diets (250 mmol/24 hours×7 days) separated by a 2-week washout period. Brain natriuretic peptide; plasma renin activity; 24-hour urinary aldosterone, sodium, and potassium; 24-hour ambulatory blood pressure monitoring; aortic pulse wave velocity; and augmentation index were compared between dietary treatment periods. At baseline, subjects were on an average of 3.4±0.5 antihypertensive medications with a mean office BP of 145.8±10.8/83.9±11.2 mm Hg. Mean urinary sodium excretion was 46.1±26.8 versus 252.2±64.6 mmol/24 hours during low- versus high-salt intake. Low- compared to high-salt diet decreased office systolic and diastolic blood pressure by 22.7 and 9.1 mm Hg, respectively. Plasma renin activity increased whereas brain natriuretic peptide and creatinine clearance decreased during low-salt intake, indicative of intravascular volume reduction. These results indicate that excessive dietary sodium ingestion contributes importantly to resistance to antihypertensive treatment. Strategies to substantially reduce dietary salt intake should be part of the overall treatment of resistant hypertension.
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Reducing dietary sodium intake to levels significantly below the level of usual intake in Western societies (eg, 50 mmol/d) promptly and impressively lowered blood pressure in many individuals with resistant hypertension.
“Reducing dietary sodium intake to levels significantly below the level of usual intake in Western societies (eg, 50 mmol/d) promptly and impressively lowered BP in many individuals with RH.58”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
The most compelling support for a role of excess dietary sodium in resistant hypertension comes from the few clinical trials demonstrating marked reductions in blood pressure among patients with resistant hypertension following a reduced sodium diet.
“Perhaps the most compelling support comes from the few clinical trials demonstrating marked reductions in BP among patients with RH following a reduced sodium diet.58,161”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
The low-sodium diet also led to significant reductions in daytime, nocturnal, and 24-hour BP levels (−20.1/−9.8 mm Hg).
“The low-sodium diet also led to significant reductions in daytime, nocturnal, and 24-hour BP levels (−20.1/−9.8 mm Hg).”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
In 12 patients with true resistant hypertension taking 3.4±0.5 antihypertensive medications, a low-sodium (50 mmol/d) versus high-sodium (250 mmol/d) diet resulted in a profound reduction in average office BP (−22.7/−9.1 mm Hg) over a 7-day period.
“In 12 patients with true RH (taking 3.4±0.5 antihypertensive medications), a low-sodium (50 mmol/d) versus a high-sodium (250 mmol/d) diet resulted in a profound reduction in average office BP (−22.7/−9.1 mm Hg) over a 7-day period.58”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
In patients with resistant hypertension, 2 recent small studies have demonstrated the efficacy of a reduced dietary sodium intake for BP lowering.
“In patients with RH, 2 recent small studies have demonstrated the efficacy of a reduced dietary sodium intake for BP lowering.58,161”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
Available studies support that sodium restriction, even to low levels <65 to 100 mmol/d (1.5-3.0 g/d), yields significant linear reductions in BP among patients with high BP and resistant hypertension.
“For the time being, the available studies (albeit of short-term duration) support that sodium restriction, even to low levels <65 to 100 mmol/d (1.5–3.0 g/d), yields significant linear reductions in BP among patients with high BP153–155,349 and RH.58,161”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [58]
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References 50 · Cited by 531
Research works printed but not linked: 1
- [16]The Trials of Hypertension Prevention Collaborative Research Group Effect of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal levels. The Trials of Hypertension Prevention, Phase II JAMA 1997 157 657 667 9080920
- Authors
- Pimenta, E., Gaddam, K. K., Oparil, S., Aban, I., Husain, S., Dell'Italia, L. J., & Calhoun, D. A.
- Affiliations
- The University of Queensland (AU)
- From the Endocrine Hypertension Research Centre and Clinical Centre of Research Excellence in Cardiovascular Disease and Metabolic Disorders (E.P.), University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia; and the Vascular Biology and Hypertension Program (K.K.G., S.O., I.A., S.H., L.J.D., D.A.C.), University of Alabama at Birmingham.
- Venue
- Hypertension
- Published
- 2009-09
- Volume
- 54
- Issue
- 3
- Pages
- 475-481
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2771382
- OpenAlex
- W2145989311
- Cited by
- 531
- References
- 50
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 23 · 2023: 20 · 2022: 18 · 2021: 19 · 2020: 27 · 2019: 30 · 2018: 21 · 2017: 37 · 2016: 37 · 2015: 46 · 2014: 54 · 2013: 47 · 2012: 50
- FWCI
- 41.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-075614, R01HL075614, P50HL077100)
- National Center for Research Resources (M01RR000032)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- resistant hypertension, dietary sodium restriction, salt sensitivity, blood pressure, ambulatory blood pressure, sodium excretion, plasma renin activity, brain natriuretic peptide, aldosterone, intravascular volume, pulse wave velocity, augmentation index
- MeSH terms
- Adult, Aged, Aldosterone, Blood Pressure, Creatinine, Diet, Sodium-Restricted, Dose-Response Relationship, Drug, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Potassium, Renin, Sodium, Sodium, Dietary, Time Factors, Body Mass Index, Cross-Over Studies, Natriuretic Peptide, Brain
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