Irreversible and reversible components in the genesis of hypertension by sodium chloride (salt)

Abstract

Despite the abundant studies and overwhelming evidences demonstrating the essential role of salt (sodium chloride) for developing "essential" hypertension (EH), the controversies about salt-hypertension (HT) relations are still continuing. One of important mistakes in this topic is assuming that the HT-producing effect of salt is reversible. The present paper explains the complex nature of salt-HT relations. The deduction was made basing on the studies which investigate the relations between salt and HT. Animal experiments show that HT-producing effect of salt contains irreversible and reversible components. The existence of irreversible component manifests itself in this way: the blood pressure (BP) does not recede to the natural values despite removing of salt exposure. The proportion of BP decreasing after salt exposure termination belongs to the reversible component. Available evidences indicate that the irreversible component is developed in utero, during suckling and, generally, in prepubertal period secondary to salt exposure, however, if the salt exposure extends over more than one period, the HT may be intensified. The consequences of salt exposure during early life of human beings have not been investigated as detailed as in experimental animals, however, there are some clinical trials and epidemiological observations indicating that, similar to experimental animals, irreversible and reversible components are also developed in man during the genesis of HT. By the introduction of irreversible and reversible components notion, some obscured items on salt-HT relations can be clarified. For example, some intervention studies could not find dramatic relations between salt and HT, because these interventions modify only the reversible component, but irreversible component remains unchanged. As a result, salt exposure is detrimental for each period of life. For eradication of HT, it is prerequisite to prevent all individuals (especially pregnant or lactating women, and children) from salt exposure. In this condition, the new generation will be free from HT.