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Clinical Modifiers of Salt Sensitivity: A Metaregression and Risk Translation Study
Szu-Han Chen1, Chih-Yu Yeh1, Yu-Pan Chiang-Lin1
1School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.-H.C., C.-Y.Y., Y.-P.C.-L., H.-M.C.).
Hypertension (Dallas, Tex. : 1979)
|July 23, 2026
Summary
Sodium restriction benefits vary significantly based on individual salt sensitivity, which is influenced by age and baseline blood pressure. Identifying these factors can personalize sodium reduction strategies for better cardiovascular event prevention.
Area of Science:
- Cardiovascular Science
- Clinical Nutrition
- Hypertension Research
Background:
- Current hypertension guidelines recommend uniform sodium restriction.
- Determinants of salt sensitivity (sodium-blood pressure responsiveness) are not fully quantified.
- This study aimed to quantify the population sodium-blood pressure dose-response and identify clinical modifiers.
Purpose of the Study:
- Estimate the population sodium-blood pressure dose-response.
- Identify clinical modifiers of salt sensitivity.
- Quantify the prevalence of high salt sensitivity.
- Determine the number needed to restrict sodium intake to prevent one cardiovascular event across clinical strata.
Main Methods:
- Searched PubMed, Embase, and Cochrane for sodium intervention trials and observational studies up to April 2025.
- Standardized blood pressure response per 50-mmol/d sodium difference.
- Used random-effects metaregression to evaluate clinical modifiers.
- Defined a highly salt-sensitive phenotype as a systolic blood pressure (SBP) decrease ≥3 mm Hg per 50-mmol/d sodium reduction.
Main Results:
- Included 160 studies (255 estimates; n=16,443).
- Each 50-mmol/d higher urinary sodium excretion was associated with a 1.76-mm Hg higher SBP.
- Age and baseline SBP were key modifiers, with prevalence of salt sensitivity rising significantly with age and SBP.
- The number needed to restrict sodium intake ranged from ≈1334 in younger, normotensive, lean individuals to ≈87 in older adults with hypertension and elevated BMI.
Conclusions:
- Salt sensitivity varies significantly across age, SBP, and BMI strata.
- Routinely measured clinical characteristics can help identify populations with a greater expected blood pressure response to sodium reduction.
- Personalized sodium reduction strategies may improve cardiovascular event prevention.
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