Salt in Hypertension and the Effects of Diuretics

Abstract

Shortly after hypertension was recognized as a clinical disorder Ambard & Beaujard (1) in 1904 proposed that it was due to a failure to adapt to an excess of salt in the diet. In this country Allen (2) was the first to carry out careful dietary studies showing that severe restriction of salt in the diet reduced blood pressure in about 60% of hypertensive patients. Allen, like the French before him, believed that hypertension was due to an unknown renal defect with respect to the excretion of salt. His work was not generally accepted, however, and it was not until 25 years later that the dietary treatment of hypertension was finally popularized by Kempner (3) with his so-called rice-and-fruit diet. Whereas Kempner believed the antihyperten­ sive effect of the diet was due primarily to protein restriction it was later demonstrated conclusively by Murphy (4) and by Watkin et al (5) that it was due to the extremely low sodium content of the diet. These clinical reports called attention to the importance of salt in the maintenance of hypertension, which in recent years has received additional strong support from epidemiological studies.