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Too much of a good thing

Comment by Paul Leeson, EACPR Exercise, Basic and Translational Research Section together with Adam Lewandowski and Esther Davis


Salt has traditionally been considered a symbol of friendship because of its lasting quality. However, in excess, we now know its lasting effects are not friendly to the cardiovascular system.

The exact mechanisms of the association between chronic salt intake and hypertension have remained unclear but may relate to salt induced endothelial and vascular damage. J.P. Forman et al. investigated this possibility through a study of approximately 4000 normotensive individuals in their 40s from the PREVEND study. They were followed over a 6 to 9 year period and had sodium intake assessed by urinary sodium excretion, as well as measures of serum uric acid and urinary albumin excretion. They also studied the relationship of these markers to the risk of development of hypertension. They found that in those individuals without hypertension, consumption of high levels of dietary sodium was associated with increases in both serum uric acid and urinary albumin excretion. Furthermore, hypertension developed in individuals when sodium intake was associated with levels of serum uric acid and urinary albumin excretion above the highest tertile for these biomarkers.
The authors argue that high serum uric acid levels reflect endothelial dysfunction and therefore, when sodium intake is sufficient to induce endothelial dysfunction and vascular damage over a prolonged period of time, hypertension develops.