Treating salt-sensitive hypertension: what medication is most effective?

This study investigated the effectiveness of different types of medication to treat salt-sensitive hypertension. The authors suggested that calcium channel blockers were the most effective class of drug in combination with hydrochlorthiazide (standard) or metformin (patients with obesity).

Salt-sensitive hypertension (SSH) is high blood pressure caused by inadequate excretion (removal) of salt. As a result of salt sensitivity it can be difficult to manage blood pressure levels. SSH also increases the chance of developing cardiovascular disease and other conditions.

SSH is treated by using medication to reduce blood pressure levels, called anti-hypertensives. There are many anti-hypertensive drugs available and they are classified based on their mechanism of action (how they reduce blood pressure). Currently, there are no recommendations on the optimal anti-hypertensive treatment for patients with SSH.

This study investigated the effectiveness of different classes of anti-hypertensives in the treatment of SSH. This report compared data from 25 clinical studies, including 1,935 patients. In these studies patients with SSH were prescribed a number of different types of medication including ACEi (angiotensin-converting enzyme inhibitors), ARB (angiotension receptor blockers), alpha-2 agonists, CCB (calcium channel blockers), beta-blockers, thiazides or a combination of these. 

Clonidine (an alpha-2 agonist) combined with low salt intake was most effective in reducing mean arterial blood pressure (MABP; pressure in the main artery). CCB combined with hydrochlorthiazide and moderate salt intake was most effective compared to other treatments. For patients with obesity, CCB combined with metformin (a drug to lower blood sugar) and a normal diet was most effective at reducing MABP.

They concluded that calcium channel blockers were the most effective class of drug in combination with hydrochlorthiazide (standard) or metformin (patients with obesity).

As this study compared data from 25 previous trials, many parameters varied including the design and number of patients. A controlled trial testing each combination of medications would tell us more about the ideal drug therapy for SSH.

If you have any concerns regarding treatment of hypertension, please discuss with your doctor.