SALT RESTRICTION COMBINED WITH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKADE IS A POTENT ANTIHYPERTENSIVE STRATEGY IN PATIENTS WITH PRIMARY ALDOSTERONISM

Abstract

Objective: The relationship between high dietary salt intake and high blood pressure is well established. Recommendations for salt restriction have found their way into major guidelines for essential hypertension. Patients with primary aldosteronism (PA), the most common endocrine cause of arterial hypertension, are believed to be exquisitely salt sensitive, i.e., respond particularly well to salt restriction. However, surprisingly little efforts have been made to determine the precise impact of salt restriction in patients with PA. We, therefore, set out to implement a moderate salt restriction in patients with PA to assess its impact on blood pressure and secondary health outcomes. Design and method: We used nutritional education and continuous self-monitoring via a smartphone app to reduce salt intake in 41 patients with PA for a time span of 12 weeks. All patients were on mineralocorticoid receptor antagonist therapy and had stable blood pressure. Patients were monitored every 4 weeks with blood pressure and urine sampling and detailed blood work at weeks 0 and 12. Mental well-being was addressed by validated scoring systems. Results: Patients achieved a significant reduction of dietary salt intake (from 9.1 to 5.2 g/d) and of blood pressure (from 130/84 to 121/81 mmHg). We also registered a significant loss of body weight (-1.4 kg). While subjects initially featured PHQD scores compatible with depression, scores normalized at the end of the study. Multivariate regression analysis revealed that cumulative intake of drugs targeting the renin-angiotensin-aldosterone system was an independent predictor of blood pressure reduction. Conclusions: Salt restriction is an effective treatment in patients with PA. Patient empowerment by education and self-monitoring promotes salt restriction. Effects are facilitated by concomitant RAAS blockade. Salt restriction, despite being moderate, also improves mental well-being.