Salt intake and reductions in arterial pressure and proteinuria. Is there a direct link?

The preponderance of the medical literature supports the concept that modest or moderate dietary salt restriction enhances the blood pressure lowering responses to most antihypertensive medications and may permit either dose reduction or, in a few cases, complete drug withdrawal. Moreover, reduction in salt intake has a permissive action on the antiproteinuric responses of angiotensin converting enzyme inhibitors and nondihydropyridine calcium channel blockers. It does not, however, affect proteinuria in those receiving dihydropyridine calcium channel blockers. The importance of selecting out those individuals who can most benefit from dietary salt modification (the "salt sensitive" groups of hypertensive patients) is important. Prospective randomized clinical studies are needed to assess the correlation between dietary salt intake and renal endpoints, such as time dialysis. This will be particularly important in different demographic groups that may have a greater predisposition to salt sensitivity, such as elderly or obese hypertensives, hypertensives of black or Hispanic descent, and those with non-insulin-dependent diabetes mellitus.