SALT INTAKE AND HYPERTENSIVE RENAL INJURY IN AFRICAN-AMERICANS - A THERAPEUTIC PERSPECTIVE

Hypertensive renal injury is a major identifiable cause of end-stage r enal disease in African-Americans. A complex nexus of sociologic, biol ogic, environmental, and sociocultural variables are involved in media ting this risk and interrelate with dietary salt consumption and salt sensitivity. It is likely that dietary salt intake and salt sensitivit y are linked in influencing the risk of hypertensive renal injury, sin ce it has been demonstrated that increasing dietary salt in salt-sensi tive patients such as African-Americans results in an increase in glom erular filtration fraction and proteinuria. Dietary salt likely influe nces both carbohydrate metabolism and blood pressure, either directly or through its influence on other ions such as calcium or potassium. T he interrelationship between salt and pharmacologic interventions is a n important clinical issue, since the efficacy of these therapies is i nfluenced by the amount of salt in the diet. It is also likely that th e changes in blood pressure and carbohydrate metabolism induced by gre ater dietary salt intake may be more specifically corrected by some no npharmacologic or pharmacologic interventions compared to others. Sinc e dietary salt has identifiable influences on blood pressure, renal he modynamics, and carbohydrate metabolism, its overall effect on cardiov ascular risk, particularly in high-risk groups such as African-America ns, assumes increasing importance.