Recommending salt intake reduction to the hypertensive patient: more than just lip service

The average individual dietary salt intake largely exceeds the physiological needs almost worldwide. A direct causal association between salt intake and blood pressure levels has been clearly established. Furthermore, there is increasing evidence for additional blood pressure-independent pathways linking excess salt intake to the process of atherosclerosis. Recent meta-analyses of randomized controlled trials showed that moderate reduction of salt intake is associated with reduction of blood pressure and, in perspective, with reduction of cardiovascular and cerebrovascular events in hypertensive individuals. According to the European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension, instructions to reduce dietary salt intake to the level of 5 g/day based on the WHO recommendation should be provided to all patients, regardless of their requirement for drug treatment. Unfortunately, the patients' response to this measure is heterogeneous, mainly due to variable compliance with the doctor's prescription and to a lesser extent to different individual BP salt sensitivity. This article discusses the factors affecting the probability of a successful intervention focusing in particular on the doctor's commitment to evaluate the patient's dietary habits, to point out the main sources of salt in the patient's diet, to provide the patient with adequate motivation and with proper instructions to implement gradual reduction of his/her salt intake, not disregarding the need for regular follow-up.