Salt Sensitivity and Hypertension in African Americans: Implications for Cardiovascular Disease

Rosalind M. Peters, MSN, RN, John M. Flack, MD, MPH

Disclosures

Prog Cardiovasc Nurs. 2000;15(4) 

In This Article

Abstract and Introduction

Hypertension is a major public health problem in the U.S. Salt sensitivity is an important factor associated with hypertension and its complications, yet it has not been addressed in the nursing literature. Salt sensitivity is a directionally appropriate rise or fall in blood pressure when salt is added or removed, respectively. The change in blood pressure in salt-sensitive subjects occurs to a degree exceeding random blood pressure fluctuations. Salt sensitivity is present in 30% of normotensive and over 50% of hypertensive persons. It is more prevalent among African Americans, older persons, and individuals with renal insufficiency or diabetes. This paper provides nurses with an overview of salt sensitivity and its significance in hypertension. It presents conceptual and operational definitions of salt sensitivity, identifies factors contributing to its development, and describes implications for nursing practice.

Hypertension is a major public health problem affecting nearly 50 million Americans. Its prevalence, however, is not evenly distributed within the population[1] (Table I). African Americans bear a disproportionate burden of this disease, with an age-adjusted prevalence of 32%.[1,2] This is a significant problem because hypertension in African Americans has an earlier age of onset, is more severe, and is associated with more pressure-related target organ damage than in whites.[1,3,4,5] In addition, in all age categories, there is a higher prevalence of Stage 3 hypertension (≥180/110 mm Hg) in African Americans.[1] As a result, African Americans suffer more frequent and severe sequelae from this disease than nonblacks, even at similar levels of blood pressure. The risks of pressure-related target organ damage, such as left ventricular hypertrophy (LVH), coronary artery disease, and nephrosclerosis, are disproportionately higher in African American hypertensives compared to Caucasians.[3,4,5] Moreover, once target organ damage develops, the risk for adverse hypertension-related sequelae rises at least three-fold at a given blood pressure level.

The noted disparities in incidence, prevalence, and severity of hypertension in African Americans have usually been attributed to differential distribution of either genetic and/or environmental risks when compared with Caucasians. Salt sensitivity is a correlate of hypertension that has both environmental and genetic components and appears to be more prevalent among African Americans than other racial or ethnic groups in America. Nevertheless, salt sensitivity is not unique to any racial/ethnic group. Therefore, understanding the concept of salt sensitivity is vitally important if cardiovascular nurses are to be effective in assisting most hypertensives, irrespective of race, to manage their hypertension and prevent its deadly complications. Yet a recent review of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database revealed that this subject has not been addressed within the nursing literature. The purpose of this paper, therefore, is to provide an overview of the literature of salt sensitivity, including how it is defined, who is at risk, what factors contribute to its development, and how it is related to hypertension, particularly among African Americans. The clinical implications for cardiovascular nurses are also discussed.

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