The salt-sensitivity of blood pressure (BP) refers to the interindividual difference in the BP response to a given change in salt intake. The majority of individuals have a decrease in BP with reduction in dietary salt intake, with a small proportion of subjects showing no response or even some increase in BP. In fact, the BP response to changes in salt intake behaves as a continuous variable with a simil-Gaussian distribution, 1, 2 not allowing to detect any distinct subpopulation. 3 This notwithstanding, based on these responses, individuals are often defined either salt-sensitive or salt-resistant using particular maneuvers and “arbitrary” cut-offs. 4 Noteworthy, salt-sensitivity of BP was associated with several cardiometabolic risk factors, among which excess body weight, diabetes and metabolic syndrome, 5, 6 and even with a high rates of organ damage and cardiovascular events. 7–9 Qi and collaborators, 10 in an article recently published in this journal, reported the results of a network meta-analysis, which compared the efficacy of different classes of antihypertensive agents in adult patients with salt-sensitive hypertension and without concomitant diseases. The main findings indicated a greater BP effect of the calcium antagonistdiuretic (hydrochlorothiazide) combination, while the calcium antagonist-metformin association was most effective in obese patients. The results also showed that clonidine was more effective during low salt intake, although only one study explored the effect of this particular antihypertensive agent. A limitation of this study was given by the different methods used to evaluate the BP salt-sensitivity. Another limitation was the inclusion in the analysis of both randomized and nonrandomized controlled trials, the majority of which were based on the use of calcium antagonists. Finally, there was a large heterogeneity in the characteristics of the different studies with respect to length of follow-up, sample size, and different dosage and form of the antihypertensive agents under investigation.

An interesting finding of the study was the apparent sodium-induced attenuation of BP lowering during high salt intake. This trend seems to be opposite to the positive relationship between salt intake and BP levels, and to the results of the beneficial effect of the reduction in salt intake on organ