Moderate dietary salt restriction reduces BP and depressive symptoms in patients with primary aldosteronism: The Salt CONNtrol trial
Germany: A recent study published in the Journal of Internal Medicine found that moderate dietary salt intake restriction in patients with primary aldosteronism (PA) substantially reduces blood pressure (BP) and improves mental well-being.
The findings from the clinical trial underline that a sufficient RAAS (renin-angiotensin-aldosterone-system) blockade seems to augment the effects of salt restriction on cardiovascular risk and BP.
Primary aldosteronism- a condition in which the adrenal glands make too much of the hormone aldosterone- is a common cause of secondary hypertension. The combination of aldosterone excess and high dietary salt intake leaves affected patients with a higher risk of cardiovascular disease than patients with hypertension from other causes. Mineralocorticoid antagonists are the main treatment of primary aldosteronism, but these medications do not completely normalize patients’ elevated cardiovascular risk.
Because elevated aldosterone and high dietary salt intake harm patients’ health, investigators wondered whether salt restriction might benefit patients. In the non-randomized single-arm Salt CONNtrol trial that included 41 patients, moderate salt restriction reduced blood pressure and depressive symptoms without detectable adverse effects.
The study revealed the following findings:
- Dietary salt intake significantly decreased from 9.1 to 5.2 g/d at the end of the study.
- In parallel, systolic (130 vs. 121 mm Hg) and diastolic blood pressure (BP) (84 vs. 81 mm Hg) improved significantly.
- Patients’ aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4 g/d).
- Salt restriction entailed a significant weight loss of 1.4 kg, improvement in pulse pressure (46 vs. 40 mm Hg) and normalization of depressive symptoms (PHQD scale).
- Salt restriction, cortisol after dexamethasone suppression test and dosage of RAAS blockers were independently associated with BP reduction.
“The study shows that a moderate dietary salt restriction is feasible when combined with a dedicated smartphone app for continuous motivation and has a strong antihypertensive effect in patients with primary aldosteronism,” said corresponding author Christian Adolf, MD, of the Ludwig Maximilian University of Munich, in Germany. “Our findings will help to improve care for patients with primary aldosteronism and, likely, also for subgroups of patients with essential hypertension.”
Reference:
Holger Schneider, Anna-Lina Sarkis, Lisa Sturm, Vera Britz, Andreas Lechner, Anne L. Potzel, Lisa Marie Müller, Daniel A. Heinrich, Heike Künzel, Hanna F. Nowotny, Thomas Marchant Seiter, Sonja Kunz, Martin Bidlingmaier, Martin Reincke, Christian Adolf, First published: 22 March 2023 https://doi.org/10.1111/joim.13618.
