“… if too much salt is added in foods the pulse hardens”. This statement appearing in the Yellow Emperor Textbook of Internal Medicine (c2500 BC) indicates that a causal relation between sodium intake and blood pressure was already taken for granted in Ancient China some 4,500 years ago. Therefore our contemporary understanding that healthy diets are basically low in sodium has historical roots which finally attracted the interest of scientists of the twentieth century who provided controlled evidence that Kempner’s rice diets reduced blood pressure because of their low sodium content. With that demonstration sodium restriction was identified as an effective treatment for hypertension to be controlled by continuous monitoring of urinary sodium over time. The list of papers on blood pressure profiles in people from low and high salt culture, going from populations with virtually no sodium intake to population with excessive sodium intake has widened the cultural horizons. This allowed Page to suggest in 1980 that “when all individuals of a population ingest small amounts of sodium, blood pressure does not increase with age and hypertension is virtually absent. When all members of the populations are ingesting large amount of sodium a high percentage develop hypertension. Between these extremes the relationship between blood pressure and sodium intake is difficult to perceive because of wide variation in genetic susceptibility and other type of “noise” introduced by other variables. The relationship, nevertheless, probably is present in all populations. A moderate reduction in sodium intake to 70 mmol/day would do no harm, and might do a great deal of good”. Further advancement was achieved by learning that a small addition of sodium to the milk in feeding newborn babies significantly increased their blood pressure within short time. Finally clinical trials in the last decade have shown a reduction in blood pressure following a restriction in sodium intake in non-hypertensive persons ingesting typical American meals and have fixed at 65 mmol per day the ideal target of sodium intake. Although there are still reports and personal views not foreseeing benefits in blood pressure control by associating sodium restriction to antihypertensive drugs, there is good evidence of additive blood pressure lowering when sodium restriction is the associated with diuretics, ACE-inhibitors and beta-adrenergic blockers and Angiotensin II receptor blockers. However a reduction of sodium intake does not impact blood pressure readings in hypertensive patients receiving calcium-channel blockers.

THE IMPACT OF SALT RESTRICTION ON THE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY

CIRILLO, Massimo
2014

Abstract

“… if too much salt is added in foods the pulse hardens”. This statement appearing in the Yellow Emperor Textbook of Internal Medicine (c2500 BC) indicates that a causal relation between sodium intake and blood pressure was already taken for granted in Ancient China some 4,500 years ago. Therefore our contemporary understanding that healthy diets are basically low in sodium has historical roots which finally attracted the interest of scientists of the twentieth century who provided controlled evidence that Kempner’s rice diets reduced blood pressure because of their low sodium content. With that demonstration sodium restriction was identified as an effective treatment for hypertension to be controlled by continuous monitoring of urinary sodium over time. The list of papers on blood pressure profiles in people from low and high salt culture, going from populations with virtually no sodium intake to population with excessive sodium intake has widened the cultural horizons. This allowed Page to suggest in 1980 that “when all individuals of a population ingest small amounts of sodium, blood pressure does not increase with age and hypertension is virtually absent. When all members of the populations are ingesting large amount of sodium a high percentage develop hypertension. Between these extremes the relationship between blood pressure and sodium intake is difficult to perceive because of wide variation in genetic susceptibility and other type of “noise” introduced by other variables. The relationship, nevertheless, probably is present in all populations. A moderate reduction in sodium intake to 70 mmol/day would do no harm, and might do a great deal of good”. Further advancement was achieved by learning that a small addition of sodium to the milk in feeding newborn babies significantly increased their blood pressure within short time. Finally clinical trials in the last decade have shown a reduction in blood pressure following a restriction in sodium intake in non-hypertensive persons ingesting typical American meals and have fixed at 65 mmol per day the ideal target of sodium intake. Although there are still reports and personal views not foreseeing benefits in blood pressure control by associating sodium restriction to antihypertensive drugs, there is good evidence of additive blood pressure lowering when sodium restriction is the associated with diuretics, ACE-inhibitors and beta-adrenergic blockers and Angiotensin II receptor blockers. However a reduction of sodium intake does not impact blood pressure readings in hypertensive patients receiving calcium-channel blockers.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11386/4306253
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