Author: Prof. Murielle Bochud

Hypertension is defined as resistant to therapy when the prescribed drug treatment fails to control blood pressure (BP) and to achieve recommended targets, and the inadequate BP control is confirmed by outof-office BP monitoring in patients whose adherence to therapy has been confirmed [1]. This definition implies that 3 antihypertensive drugs are prescribed at maximally tolerated doses with one of them being a diuretic. In recent years, additional definitions have appeared in the literature [2]. They include the concept of refractory hypertension, when BP remains uncontrolled with the use of 5 antihypertensive agents of different classes, including a long-acting thiazide-like diuretic and spironolactone, or controlled resistant hypertension, when BP falls below targets on 4 antihypertensive medications at maximal or maximally tolerated doses [2]. Frequently, however, uncontrolled hypertension is considered as ‘apparent’ rather than true resistant hypertension because BP has not been measured outside the office, drug adherence has not been assessed and other factors of pseudo-resistance have not been excluded [3].

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Abstract: As a part of the salt controversy, it has been suggested that people with a low sodium intake have an increased risk of cardiovascular events. However, there is no clear explanation for this increased risk. We examined the socio-demographic, clinical profile, and behavioral factors associated with a low sodium intake in the Swiss subjects who participated in the Swiss Survey on Salt. Only 13.3% of the Swiss population eat less than 5 g of salt daily and among them 78.2% are women. Subjects with a low sodium intake eat and drink less as reflected by lower intakes of proteins, potassium, and calcium and a smaller urine volume. In addition, a low blood pressure, a normal body mass index, a low prevalence of obesity, a low serum uric acid, and less alcohol and cigarette consumption characterized this group, suggesting a rather low cardiovascular risk profile. Being single and doing most of the cooking at home are associated with a low intake of sodium, as well as a less frequent consumption of meat and fish when eating less than 5 g salt per day. However, the awareness of the effects of salt on health and cardiovascular risk, health concerns, and physical activity are similar in subjects eating more or less salt. In conclusion, we could not evidence clinical or behavioral factors that could significantly increase the risk of developing cardiovascular events in low salt eaters.

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