Can moderate dietary salt restriction help patients with hypertension?
Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: the salt CONNtrol trial
Background
Primary aldosteronism ( PA) is a common cause of hypertension. Excess aldosterone together with high dietary salt intake aggravates cardiovascular damage, despite guideline-recommended mineralocorticoid receptor antagonist (MRA) treatment.
Goals
To investigate the antihypertensive impact of moderate dietary salt restriction and associated physiological changes, including mental well-being.
Methods
A total of 41 patients with AP on a stable antihypertensive regimen, including MRA, followed dietary salt restriction for 12 weeks with structured nutritional training and consolidation using a mobile health application. Salt intake and adherence were monitored every 4 weeks using 24-hour urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well-being by validated questionnaires.
Results
Dietary salt intake decreased significantly from 9.1 to 5.2 g/d at the end of the study. In parallel, systolic (130 vs. 121 mm Hg) and diastolic blood pressure (BP) (84 vs. 81 mm Hg) improved significantly.
Patients’ ability to estimate dietary salt content was significantly refined (underestimation of 2.4 vs. 1.4 g/d). Salt restriction led to a significant weight loss of 1.4 kg, improvement in pulse pressure (46 vs 40 mmHg) and normalization of depressive symptoms (PHQD scale, p < 0.05).
Salt restriction, cortisol after dexamethasone suppression test, and dose of renin-angiotensin-aldosterone system (RAAS) blockers were independently associated with BP reduction.
Conclusion
Moderate restriction of dietary salt intake in patients with primary aldosteronism (PA) substantially reduces BP and depressive symptoms. Furthermore, the findings underscore that sufficient RAAS blockade appears to increase the effects of salt restriction on BP and cardiovascular risk.
Comments
Results from a clinical trial published in the Journal of Internal Medicine reveal several health benefits of moderate salt restriction in patients receiving standard medical treatment for primary aldosteronism .
Primary aldosteronism, a condition in which the adrenal glands produce too much of the hormone aldosterone, is a common cause of secondary hypertension. The combination of excess aldosterone and high dietary salt intake leaves affected patients with a higher risk of cardiovascular disease than patients with hypertension from other causes. Mineralocorticoid antagonists are the main treatment for primary aldosteronism, but these medications do not completely normalize patients’ elevated cardiovascular risk.
Because elevated aldosterone and high dietary salt intake have detrimental effects on patients’ health, researchers wondered whether salt restriction could benefit patients. In the non-randomized single-arm Salt CONNtrol trial that included 41 patients, moderate salt restriction reduced blood pressure and depressive symptoms without detectable adverse effects.
"The study shows that a moderate dietary salt restriction is feasible, when combined with a dedicated smartphone application for continuous motivation, and has a strong antihypertensive effect in patients with primary aldosteronism," said corresponding author Christian Adolf. , MD, from the Ludwig Maximilian University of Munich, Germany. “Our findings will help improve care for patients with primary aldosteronism and probably also for subgroups of patients with essential hypertension.”
