Excessive dietary sodium intake and elevated blood pressure: a review of current prevention and management strategies and the emerging role of pharmaconutrigenetics

Precision medicine has the potential to improve current standard of care for patients, especially in the cardiovascular field. Better prevention and treatment of cardiovascular disease (CVD) remains a public health concern globally as the disease affects a considerable proportion of populations in many countries.1 CVD progression can be in part prevented with effective management of blood pressure through nutritional, pharmacological and lifestyle approaches.2 3 Nutritional approaches to reduce blood pressure has in part focused on sodium intake as part of a nutritional intervention plan, although this established approach may be more effective for individuals who are salt sensitive, a phenotype that is currently not considered clinically. Blood pressure for individuals who are salt sensitive will change depending on the level of sodium intake, while those who are salt resistant will not see a change in their blood pressure even when sodium intake varies. This difference in response to sodium and its associated effect on blood pressure makes it important to be able to stratify the population based on this response to be able to effectively guide dietary intake. Nutrigenetics, which incorporates genetic markers in dietary intervention approaches, is one promising way this salt sensitivity phenotype can be identified among individuals. In addition, for those receiving antihypertensive agents to control blood pressure, using genetic markers to help with drug selection, or using a pharmacogenetic approach, may be a better way of achieving improved efficacy, lower adverse events and lead to more efficient use of limited healthcare resources. Current methods to manage blood pressure and sodium intake and the emerging role of precision medicine will be explored. More specifically, the use of genetics in nutritional and pharmacological interventions, or pharmaconutrigenetics, to guide sodium intake and manage blood pressure will be discussed as a way to better prevent and manage CVD …