Salt Intake, Endothelial Dysfunction, and Salt‐Sensitive Hypertension

Numerous epidemiologic and clinical studies have demonstrated a clear relationship between high salt intake and blood pressure. However, the mechanisms of a salt‐induced increase in blood pressure—a phenomenon known as salt sensitivity—and the heterogeneity of this effect are far from being completely understood. Endothelial dysfunction, and especially the nitric oxide system, is implicated in both experimental and clinical hypertension. Animal studies indicate that endogenous nitric oxide plays an important role in renal hemodynamics and sodium homeostasis, inducing renal vasodilation and natriuresis. Studies of essential hypertensive patients have also suggested that both high salt intake and salt sensitivity are associated with impaired endothelial function. Although there are many hypotheses concerning the nature of salt sensitivity, clinical data indicate that salt‐sensitive patients may be unable to up‐regulate the production of nitric oxide in response to salt intake. This endothelial dysfunction, which is more frequent in salt‐sensitive than in salt‐resistant essential hypertensive patients, may partially explain the blood pressure increase in response to salt intake and may underlie the more pronounced target organ damage and cardiovascular risk in salt‐sensitive patients.