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Schneider, H.* ; Sarkis, A.L.* ; Sturm, L.* ; Britz, V.* ; Lechner, A. ; Potzel, A. ; Müller, L.M.* ; Heinrich, D.A.* ; Künzel, H.* ; Nowotny, H.F.* ; Seiter, T.M.* ; Kunz, S.* ; Bidlingmaier, M.* ; Reincke, M.* ; Adolf, C.*

Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: The salt CONNtrol trial.

J. Intern. Med. 294, 47-57 (2023)
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Open Access Gold (Paid Option)
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BACKGROUND: Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline-recommended mineralocorticoid receptor antagonist (MRA) treatment. OBJECTIVES: To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well-being. METHODS: A total of 41 patients with PA on a stable antihypertensive regimen-including MRA-followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24-h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well-being by validated questionnaires. RESULTS: Dietary salt intake significantly decreased from 9.1 to 5.2 g/d at the end of the study. In parallel, systolic (130 vs. 121 mm Hg) and diastolic blood pressure (BP) (84 vs. 81 mm Hg) improved significantly. Patients' aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4 g/d). Salt restriction entailed a significant weight loss of 1.4 kg, improvement in pulse pressure (46 vs. 40 mm Hg) and normalization of depressive symptoms (PHQD scale, p < 0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin-angiotensin-aldosterone-system (RAAS) blockers were independently associated with BP reduction. CONCLUSION: A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Aldosterone ; Cardiovascular Risk ; Hypertension ; Mineralocorticoid Receptor Antagonist ; Salt Restriction ; Salt Sensitivity ; Sodium; Sensitive Neurons; Solitary Tract; Reduction; Mortality; Nucleus
ISSN (print) / ISBN 0954-6820
e-ISSN 1365-2796
Journal Journal of Internal Medicine
Quellenangaben Volume: 294, Issue: 1, Pages: 47-57 Article Number: , Supplement: ,
Publisher Wiley
Publishing Place 111 River St, Hoboken 07030-5774, Nj Usa
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) CCG Biomarker for the subclassification of T2DM (KKG-KDB)
Grants German Center for Diabetes Research
LMU Klinikum
Helmholtz Zentrum Muenchen
Else Kroener-Fresenius Stiftung
FoeFoLe
Else Kroener-Fresenius-Stiftung
Eva Luise und Horst Koehler Stiftung AMP
Deutsche Forschungsgemeinschaft (DFG) (within the CRC/Transregio 205/2 "The Adrenal: Central Relay in Health and Disease" within the Clinician Scientist Program In Vascular MEdicine (PRIME)
European Research Council (ERC) under the European Union
Else Kroener-Fresenius Stiftung in support of the German Conn's Registry-Else-Kroener Hyperaldosteronism Registry