Abstract
Hypertension is known as the “silent killer,” driving the global public health burden of cardiovascular and renal disease. Blood pressure homeostasis is intimately associated with sodium balance and the distribution of sodium between fluid compartments and within tissues. On a population level, most societies consume 10 times more salt that the 0.5 g required by physiological need. This high salt intake is strongly linked to hypertension and to the World Health Organization targeting a ∼30% relative reduction in mean population salt intake to arrest the global mortality due to cardiovascular disease. But how does a habitually high-salt diet cause blood pressure to rise? In this focused review, we discuss 2 “evolutionary medicine” concepts, presented at the ISN Forefront Meeting “Immunomodulation of Cardio-renal Function.” We first examine how ancestral variants in genes that conferred a selection advantage during early human development are now maladaptive. We then discuss the conservation of “renal” sodium transport processes across multiple organ systems, including the brain. These systems influence sodium appetite and can exert an often-overlooked effect on long-term blood pressure control.
Highlights
For most of mankind’s existence, sodium chloride was a scarce nutrient. This scarcity gave great economic value to salt and shaped the formation and customs of our societies, both ancient and modern. It is reflected in our DNA, encoding the multiple interlocking pathways that efficiently control salt balance
It is clear that BP homeostasis is intimately associated with sodium homeostasis and the distribution of sodium between fluid compartments and within tissues
This improved understanding may help us to develop therapeutic and lifestyle interventions to tame the “silent killer.”
Summary
ISN Forefronts Symposium 2015: The Evolution of Hypertension– Old Genes, New Concepts. Most societies consume 10 times more salt that the 0.5 g required by physiological need. This high salt intake is strongly linked to hypertension and to the World Health Organization targeting a w30% relative reduction in mean population salt intake to arrest the global mortality due to cardiovascular disease. We discuss the conservation of “renal” sodium transport processes across multiple organ systems, including the brain These systems influence sodium appetite and can exert an often-overlooked effect on long-term blood pressure control. The relationship between salt intake and cardiovascular mortality is u-shaped, targeting salt reduction toward the recommended daily allowance (RDA) would be beneficial[5]: based on the INTERSALT study, long-term compliance would lower blood pressure and significantly reduce cardiovascular events later in life.[6]
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