Salt sensitivity and hypertension

• Published in: Journal of human hypertension Vol. 35; no. 3; pp. 184 - 192
• Main Authors: Balafa, Olga, Kalaitzidis, Rigas G.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2021; Nature Publishing Group
• Subjects: 38; 38/23; 59; 631/443/319/1488; 692/700/459/284; Angiotensin; Blood pressure; Development and progression; Disease resistance; Endothelium; Epidemiology; Health Administration; Hypertension; Insulin; Insulin resistance; Kidney diseases; Kidneys; Medicine; Medicine & Public Health; Nitric oxide; Physiological aspects; Public Health; Renin; Review Article; Risk factors; Salt; Salt loading; Skin; Sodium in the body; Sympathetic nervous system; Greece
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/s41371-020-00407-1

Salt sensitivity refers to the physiological trait present in mammals, including humans, by which the blood pressure (BP) of some members of the population exhibits changes parallel to changes in salt intake. It is commoner in elderly, females, Afro-Americans, patients with chronic kidney disease (CKD) and insulin resistance. Increased salt intake promotes an expansion of extracellular fluid volume and increases cardiac output. Salt-sensitive individuals present an abnormal kidney reaction to salt intake; the kidneys retain most of the salt due to an abnormal over-reactivity of sympathetic nervous system and a blunted suppression of renin–angiotensin axis. Moreover, instead of peripheral vascular resistance falling, salt-sensitive subjects present increased vascular resistance due mainly to impaired nitric oxide synthesis in endothelium. Recent studies have shown that part of the dietary salt loading accumulates in skin. Hypertensive and patients with CKD seem to have more sodium in skin comparing to healthy ones. However, we still have not fully explained the link between skin sodium, BP and salt sensitivity. Finally, although salt sensitivity plays a meaningful role in BP pathophysiology, it cannot be used by the physician in everyday patient’s care, mainly due to lack of a simple and practical diagnostic test.