SODIUM-METABOLISM AND INSULIN SENSITIVITY - THERAPEUTIC IMPLICATIONS

Antihypertensive therapy needs accurate metabolic phenotyping to obtai n an effective decrement of individual cardiovascular risk. Accordingl y, the possible metabolic effects of each class of antihypertensive dr ugs have been widely studied. However, the information available on th e role of changes in sodium chloride dietary intake as a non-pharmacol ogic approach to metabolic disturbances in hypertensive patients is sc arce. Clinical and experimental data support the concept that non-obes e, non-diabetic salt-sensitive hypertensives are often insulin-resista nt, whereas matched salt-resistant patients seem to be ''protected'' a gainst the development of the so-called ''insulin-resistance syndrome' '. In accordance with this difference, short-term sodium chloride rest riction may result in a modest but significant improvement in glucose tolerance and insulin sensitivity, a finding observed only in patients experiencing a concomitant significant decrement in blood pressure. T herefore salt-sensitivity seems to be characterized by an increased ri sk of developing insulin resistance and the consequent detrimental cha nges in cardiovascular risk. Salt-sensitive individuals are likely to show the greatest metabolic benefit from salt restriction. (C) 1997, M edikal Press.