We have read with great interest the article by Dr Appel, et al titled "Effects of Reduced Sodium Intake on Hypertension Control in Older Individuals" published in a recent issue of the ARCHIVES.1 We would like to congratulate the authors and make some comments. First, they estimate as very positive the finding of an average reduction of 4 mm Hg in their population's systolic blood pressure and of 2 mm Hg in their diastolic blood pressure. These results might be statistically significant but clinically irrelevant. However, these reductions of blood pressure are not seen either in the those older than 70 years or in women of any age. Second, even if they were thought to be important, they are of lesser importance with regard to the fundamental objectives of controlling hypertension, ie, the reduction of the morbidity and mortality it causes. Other studies have also found reductions in blood pressure readings and not in morbidity or mortality.2,3 It is surprising that none of these variables is affected in the statistical analysis conducted by Appel et al. The most significant conclusion in our opinion is that elderly patients who do not reduce salt intake do not undergo any change in morbidity and mortality. Perhaps it would be a good time to initiate a much more ambitious trial where these variables are the main objectives. The palate of our older population could be in luck.
Ruíz-García V, Valdivieso B, Soriano E, Renovell V, Almazan D. Is Salt So Harmful for Hypertension in Our Elderly?. Arch Intern Med. 2001;161(21):2632–2633. doi: