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Pflugers Arch - Eur J Physiol (2015) 467:595603 DOI 10.1007/s00424-015-1690-8
INVITED REVIEW
The hidden hand of chloride in hypertension
Linsay McCallum & Stefanie Lip &
Sandosh Padmanabhan
Received: 8 October 2014 /Revised: 3 December 2014 /Accepted: 5 December 2014 /Published online: 27 January 2015 # The Author(s) 2015. This article is published with open access at Springerlink.com
Abstract Among the environmental factors that affect blood pressure, dietary sodium chloride has been studied the most, and there is general consensus that increased sodium chloride intake increases blood pressure. There is accruing evidence that chloride may have a role in blood pressure regulation which may perhaps be even more important than that of Na+.
Though more than 85 % of Na+ is consumed as sodium chloride, there is evidence that Na+ and Cl concentrations do not go necessarily hand in hand since they may originate from different sources. Hence, elucidating the role of Cl as an independent player in blood pressure regulation will have clinical and public health implications in addition to advancing our understanding of electrolyte-mediated blood pressure regulation. In this review, we describe the evidence that support an independent role for Cl on hypertension and cardiovascular health.
Keywords Salt . Chloride . Hypertension . Blood pressure . Anion
Essential hypertension is the result of a complex interplay between multiple regulatory systems which are themselves influenced by a multitude of genetic and environmental factors. Among the environmental factors that affect blood pressure, dietary sodium chloride has been studied the most, and there is general consensus that increased sodium chloride intake increases blood pressure. The role for NaCl is supported by insights from the pressure-natriuresis mechanism [30], monogenic forms of hypertension [51], and dietary salt reduction studies [16, 32, 76]. However, there is still considerable
debate about NaCl and hypertension particularly in relation to the context in which this occurs, its prognostic implications, and the role of the underlying regulatory and counter-regulatory pathways that are perturbed when salt intake is altered [2, 25, 43, 60, 62, 6567]. The blood pressure response to sodium chloride intake is referred to as salt sensitivity and while this has universal definition, a 510 % change in office blood pressure in response to a change in salt intake is indicative. Importantly,...