Salt Restriction Lowers Resting Blood Pressure but not 24-H Ambulatory Blood Pressure

Dietary salt restriction is the most common therapeutic recommendation given to hypertensives, but past studies have assessed the effect of salt restriction using resting blood pressure (BP) measurements not with the newer technique of 24-h ambulatory BP monitoring. We compared the effect of high (250 mEq Na/day) and low (10 mEq Na/day) salt diets on resting versus ambulatory BP in 12 normal and 15 hypertensive subjects. Each diet was given for 7 days. Ambulatory BP was monitored from day 6 to day 7 of each diet; resting supine BP was measured on the morning of day 8. In normal subjects, neither resting nor ambulatory BP changed with sodium restriction. In hypertensives, resting BP fell 14 +/- 3/6 +/- 2 mm Hg (systolic/diastolic; P less than .01 for both) with sodium restriction while ambulatory BP fell only 4 +/- 2/2 +/- 2 (P = NS). The resting BP fall was significantly greater than the ambulatory BP fall (P less than .05) for both systolic and diastolic pressure. Ambulatory heart rates were also significantly greater during sodium restriction, suggesting that the low salt diet activated the sympathetic nervous system. This may, in turn, have partially offset the hypotensive effect of sodium restriction. We conclude that using resting BP to assess the effect of sodium restriction may overestimate the efficacy of this therapy. Ambulatory BP monitoring should be employed in future studies of sodium restriction.