Salt controversy

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THE SALT CONTROVERSY: THE DIET " DICTOCRATS " ARE AT IT AGAIN!

http://www.redflagsweekly.com/rosch/2003_jul11.html

 

By Paul J. Rosch, MD, F.A.C.P.

THE AMERICAN INSTITUTE OF STRESS

 

Paul Rosch, MD, FACP, is clinical professor of medicine and psychiatry at

New York Medical College and is President of the American Institute of

Stress, and Honorary Vice-President of the International Stress Management

Association.

 

This column will also appear in the August edition of the Health and Stress

monthly newsletter of the American Institute of Stress

 

The " diet dictocrats " are at it again. The latest NHLBI (National Heart

Lung and Blood Institute) warning is that Americans are eating too much

salt and are therefore at increased risk for hypertension, stroke and heart

attacks. Others claim that excess sodium is a poison that can also cause

cancer and osteoporosis. NHLBI recommends that not only high blood pressure

patients but all Americans should sharply reduce their sodium intake,

regardless of age, gender or race. This is another example of the same,

stupid " one size fits all " cookie cutter approach of treating population

statistics and laboratory measurements rather than people.

 

This latest ban on sodium seems strange since salt has always been viewed

as being very valuable. In ancient Greece, slaves were traded for salt -

hence the expression " not worth his salt. " Roman soldiers were sometimes

paid in salt (salis) and their salarium is the origin of our word " salary " .

" Soldier " actually comes from the Latin (sal dare), which means, " to give

salt " .

 

In Biblical times, salt was also used to seal an agreement or contract and

was called " the covenant of salt " . Men wore a pouch of salt tied to their

belt and when they made a promise to someone, each put a pinch of salt into

the other’s pouch. If a man wanted to break his covenant for reasons that

did not seem fair, the other could respond by telling him " Yes, if you can

retrieve your grains and yours only from my pouch of salt " . Salt was

similarly used to seal a deal in Arabic countries, where it also signified

safety and friendship. If you were offered and ate salt in someone's home

it meant they would never harm you in any way and vice versa.

 

The Bible refers to the covenant of salt by which God gave the rule over

Israel forever to David and his sons and in the Law of Moses requiring that

all cereal offerings contain salt. Salt was valuable since it preserved

foods and being called the " salt of the earth " meant that you were a

valuable person. It could also refer to a group of people on whom one could

rely, as when Jesus told his disciples " Ye are the salt of the earth, …Ye

are the light of the world. " In other words they were preservatives against

the damaging and spoiling effects of worldly sin.

 

Participants at medieval feasts were seated in order of importance based on

the location of the salt dishes. Distinguished guests dined at an elegant

elevated banquet table " above the salt " . Lesser lights sat " below " in the

boondocks in progressively lower trestle type tables.

 

Mystical, Sanctifying And Practical Uses

 

Salt was also considered to be a magical substance that could bring good

fortune and prevent illness. An old Latin proverb stated " There is nothing

more useful than the sun and salt " (Nil sole et sale utilius). Since it was

essential for preserving food, spilling salt was a terrible waste that

would surely bring bad luck. This led to the belief that Satan or some evil

spirit must have been standing behind you to cause such an accident. The

best thing to do was to immediately throw three pinches of the spilled salt

over your left shoulder into his eye to blind him and scare him away. (Any

good spirits would allegedly be behind you on the right.) I vividly

remember my mother doing this and suspect it is still a common practice in

some parts of the world.

 

In " The Last Supper " , Leonardo da Vinci placed an overturned dish of salt

in front of the scowling Judas Iscariot. Some suspect that Leonardo was

aware that this represented an ill omen to prophesy the traitor's death by

hanging himself. Others believe that the superstition may have started with

this painting, since in describing the event, the scripture stated " Satan

entered into Judas " and " supper being ended, the devil having now put into

the heart of Judas Iscariot to betray him " .

 

The Druids used salt in their Stonehenge rituals because it was believed to

represent a symbol of the life-giving fruits of the earth. In old Japanese

theatres, salt was sprinkled on the stage before each performance to

prevent evil spirits from casting a spell on the actors and ruining the

play. Salt was also thought to provide sanctification. One of the four

principal tenets of the Shinto religion was the guarantee of physical

cleanliness before praying or approaching a shrine, which required lots of

sprinkling with salt and then washing.

 

This is still practiced in Sumo wrestling. The hallowed clay of the Dohyo

or sumo ring is considered a sacred spot and must be purified the day

before each tournament by the head referee and a Shinto priest, who pour

sake and salt in its center. The Dohyo is made of packed clay and consists

of a square platform with a circle made of dirt-packed straw bales imbedded

in its surface. Salt is sprinkled on this before each match to cleanse the

ring of " bad spirit " . During the warm-up period, it is not unusual to see a

wrestler sprinkling salt on his foot, bandaged knee or elbow for further

protection, before throwing the rest into the ring.

 

In the Old Testament, Elisha also purified a spring by tossing salt into

it. Nathaniel Hawthorne, whose The Scarlet Letter and other works are noted

for their treatment of guilt and the complexities of making moral choices,

similarly believed that there was something sacred about salt and wrote,

" Salt is white and pure, ? there is something holy in salt. " In some

countries, it is customary to greet newlyweds with gifts of salt and bread

to bring good luck instead of throwing confetti or rice. Roman mothers

rubbed salt on the lips of infants to protect them from illness and danger.

Though no longer common, for hundreds of years Roman Catholic priests would

place a pinch of salt on a baby's tongue during baptism and say, " Receive

the salt of wisdom. "

 

Salt was so valuable that caravans carried it across the Sahara to Eastern

trading centers to exchange for gold, ivory, slaves and skins. Salt bars

were the coin of the realm in Ethiopia for over a thousand years and cakes

of salt stamped to show their value were also used as currency in countries

from Borneo to Tibet.

 

How Did The Low Salt Crusade Start?

 

If salt was believed to be so valuable and useful in so many ways for so

many thousands of years by so many million people from so many different

cultures, why is it that we have only recently discovered that it is

dangerous? Like the conspiracy against cholesterol and fat intake, the

denunciation of sodium began little more than 50 years ago. Low salt

proponents point out that over four thousand years ago, the Yellow

Emperor's Canon of Internal Medicine stated, " too much salt stiffens the

pulse " . They interpret this as representing advanced arteriosclerosis due

to hypertension. However, unlike acupuncture, magnets and herbal remedies

that are mentioned and are still popular, there was no further reference to

this.

 

About 100 years ago, French physicians reported that restricting salt and

salty foods benefited patients with fluid retention and hypertension.

Shortly thereafter, it was found that mercurial compounds used to treat

syphilis often caused a significant diuresis, which led to the development

of mercurial drugs to treat edema. Although more effective than trying to

eliminate sodium intake, they had to be injected and often had serious side

effects. The advent of modern diuretics resulted from the equally

serendipitous observation that some patients being treated with sulfa drugs

for rheumatic fever and bacterial infections also often experienced a

significant diuresis. In 1949, Bill Schwartz reported that three patients

with marked edema due to heart failure who were given sulfonamides all

showed dramatic improvement but that these drugs were also " too toxic for

prolonged or routine use. "

 

The first proof that reducing sodium intake could benefit some patients

with hypertension also came in 1949 when Walter Kempner reported

improvement in malignant hypertension associated with kidney disease and

heart failure. The Kempner diet consisted solely of rice and certain fruits

that limited sodium intake to less than 350 mg daily and had no fat. It was

extremely hard to adhere to for more than a week or two but was preferable

to bilateral lumbar sympathectomy, the only other treatment for this lethal

disorder.

 

Karl Beyer, a research chemist, tried several variations of the sulfonamide

formula and developed Diuril (chlorothiazide). It proved to be safer and

more effective in reducing edema and it also lowered blood pressure in

hypertensive patients without evidence of significant fluid retention.

Diuril and other thiazide diuretics like Hydrodiuril and Hygroton quickly

became the treatment of choice for hypertension. Support for their use came

from animal studies showing a correlation between increased sodium content

of arterial vessels and elevated blood pressure.

 

Lewis Dahl was able to develop a strain of salt sensitive rats who

routinely developed hypertension to support his firm belief in the value of

salt restriction. This was widely heralded and cited by other low salt

proponents as proof of the role of salt in hypertension. What they often

neglect to mention is that these rats would have to be fed an amount of

salt equivalent to over 500 grams daily for an adult human. Dahl also

demonstrated a linear relationship between salt intake and blood pressure

in different populations as noted below:

 

 

 

This surely confirmed the dangers of salt for everyone and prompted the

1979 " Surgeon General's Report on Health Promotion and Disease Prevention "

condemning salt as a clear cause of high blood pressure. Since then, the

government has spent untold millions in a vain attempt to justify this

claim. Their expensive and lengthy crusade to prove a link between sodium

and hypertension began in 1984 with the $1.3 million INTERSALT study of

10,000 subjects in 52 centers around the world. As anticipated, researchers

reported that societies with higher sodium intakes also had higher average

blood pressures. A similar relationship was also allegedly shown in

individuals, thus clinching the government's case.

 

The Art Of Mining Salt Study Statistics

 

The INTERSALT study seemed to confirm Dahl's findings. However, when the

four primitive societies with both extremely low sodium intake and very low

blood pressures were excluded no such correlation was found in the other 48

groups. This was reminiscent of Ancel Keys' famous study where he " cherry

picked " seven countries out of 15 around the world and demonstrated a

straight-line relationship between animal fat and cholesterol consumption

and deaths from coronary heart disease. Had Keys selected data from the

eight other countries that were available to him the results would have

been exactly the opposite.

 

The INTERSALT researchers conveniently neglected to mention that the

population of the four countries responsible for skewing the total figures

to coincide with their preconceived conclusion also had less stress, less

obesity, ate far less processed foods and much more fiber from fruits and

vegetables. They also tended to die at younger ages from other causes and

often too soon to have developed any significant degree of coronary

atherosclerosis. Critics complained that these four societies that

distorted the average figures for sodium intake and hypertension were so

different from the rest of the groups, especially those in the U.S.A. and

U.K., that it was " like comparing apples with stringbeans rather than oranges. "

 

The Yanomami Indians in the rain forests of Brazil had mean blood pressures

of 95/61 and equally low urinary sodium levels. These primitive people had

no evidence of hypertension, obesity or alcohol consumption and their blood

pressures did not rise with age. When the available data from the other

more civilized societies was reviewed, statisticians found that as sodium

intake increased there was a decrease in blood pressure, just the opposite

of what had been reported. The lowest salt intake seemed to be in a

subgroup of Chicago black males despite the fact that their incidence of

hypertension was above average. Conversely, high blood pressure was

relatively rare in participants from China's Tianjin Province even though

this study group had the highest salt intake.

 

When confronted with these discrepancies, the researchers reanalyzed their

data in an attempt to justify their conclusions. However, the only thing

they could come up with was that a higher sodium intake could be correlated

with a faster rise of blood pressure as people grew older. This is referred

to as " mining the data " since a relationship between blood pressure and

aging was never a goal of the study. Nor did this observation address the

major purpose of determining whether increased dietary sodium was related

to higher rates of illness or death for everyone.

 

While it may be true that " figures don't lie " , liars can still figure. The

first law of statistics is that if the statistics do not support your

theory you obviously need more data. The second is that if you have enough

data to choose from, anything can be proven by statistical shenanigans. A

good example are the numerous " risk factors " for coronary heart disease

like a deep earlobe crease or premature vertex baldness that are really

" risk markers " . These simply represent statistical associations rather than

competent causes. You can't use a statistic to prove another statistic.

 

However, the anti-salt statisticians had a field day with the data from the

1999 follow-up study of NHANES (National Health and Nutrition Examination

Survey) which began tracking 20,729 Americans in 1971. They reported that

participants who ate the most salt had 32 percent more strokes, a whopping

89 percent more deaths from stroke, 44 percent more heart-attack deaths,

and 39 percent more deaths from all causes. This finally seemed to prove

precisely what the government had been preaching all along. In addition,

the study's conclusions were seemingly credible due to the large number of

subjects and a 19-year average period of observation, enough time to

determine whether people would have increased mortality rates or a higher

incidence of illness from consuming too much salt.

 

As the lead author proudly proclaimed, " Our study is the first to document

the presence of a positive and independent relationship between dietary

sodium intake and cardiovascular disease risk in adults " .

 

Pouring Salt In Low Sodium Wounds

 

However, when independent researchers reanalyzed the data they discovered

that dietary sodium intake was associated with higher rates of illness and

death only in participants who were overweight. There was no correlation

between sodium and increased cardiovascular disease risk in the remainder.

Undaunted, another study author continued to claim that the conclusions

were valid since statistics showed that more than one in three Americans

were overweight and most ate too much salt.

 

He admitted that the NHANES research " was not specifically designed to

answer " the question of sodium and health - in other words, more mining of

the data. In addition, the entire study depended on just one 24-hour recall

of sodium intake. When questioned about the dubious value of such

information he was forced to concede that " At best, the estimate for sodium

is imperfect " . He also agreed that measuring the concentration of sodium in

a 24-hour urine specimen would have provided more accurate information

about dietary habits and excess consumption.

 

Statistics are somewhat like expert witnesses in that they can be used to

testify for either side depending on what you want to prove. When Michael

Alderman, a highly regarded epidemiologist and past president of The

American Society of Hypertension scrutinized the same data in patients who

were not overweight he reported that " the more salt you eat, the less

likely you are to die. " - (from heart disease or anything else). Alderman

has long been critical of the government's low sodium diet advice for large

populations and their focus on sodium intake as it relates to blood

pressure rather than to the overall health, quality and length of life of

individuals. He examined the relationship between sodium intake and health

effects in 3,000 patients with mild to moderate hypertension. In addition,

his group measured sodium excretion, which is much more accurate than

estimating dietary intake. At the end of four years, they found that those

who consumed the least sodium had the most myocardial infarctions and other

cardiovascular complications.

 

The reason for this is that when you restrict vital nutrients like salt (or

cholesterol) all sorts of strange things can result. Low sodium diets can

increase levels of renin, LDL and insulin resistance, reduce sexual

activity in men and cause cognitive difficulties and anorexia in the

elderly. Tasteless and dull low sodium diets can cause other nutritional

deficiencies. Lowering sodium with diuretics to treat hypertension can

cause similar problems. Renin is possibly the most powerful and dangerous

blood pressure raising substance known. Indeed, the study done by

Alderman's group found that for every 2% increase in pretreatment plasma

renin activity there was a 25% increase in heart attacks. No such

correlation was found with increased sodium intake.

 

There are no research reports that justify putting everyone on a low-sodium

diet. A meta-analysis of 83 published studies that included people who had

been randomly assigned to follow a high or low sodium diet found that in

those with elevated blood pressures, a low sodium diet was able to lower

systolic pressure 3.9 mm Hg and diastolic pressure by 1.9 mm Hg. However,

in others with normal pressures, cutting salt intake reduced blood pressure

by only 1.2 mm systolic and 0.26 mm diastolic. I don't know how many of you

have ever taken a blood pressure but it is almost impossible to detect such

minute differences. If you use the standard method and take repeated blood

pressures over a few minutes each reading often varies by 5 mm. or more and

it is extremely difficult to detect a diastolic measurement difference of 2 mm.

 

These figures were arrived at because meta-analysis is a technique that

allows statisticians to look at studies that may have been designed for

different reasons but contain data on specific items that can be combined

and averaged for whatever purpose you choose. I have never been a great fan

of meta-analysis, since it often illustrates that " statistics are a highly

logical and precise method for saying a half-truth inaccurately. " Low

sodium diets may be helpful for some hypertensive patients by reducing

their need for drugs but there is no proof to support official

recommendations that they are good for everybody.

 

Slipping Through Some Legal Loop-holes.

 

As previously noted, low salt diets may not be as entirely harmless as

proponents often claim. In the meta-analysis survey, which was published in

the Journal of the American Medical Association a few years ago,

researchers reported that cholesterol and LDL " bad " cholesterol increased

with sodium reduction. More importantly, blood levels of renin and

aldosterone also rose in proportion to the degree of sodium reduction. This

compensatory response to increase blood volume would tend to raise blood

pressure and possibly the likelihood of cardiovascular complications. Since

the government began promoting sodium restriction and diuretics three

decades ago, the incidence of hypertension and strokes has increased and

the previous declining rate of heart attacks has leveled off.

 

Investigators from the Salt Institute also wondered why there would be any

dramatic rise with age if population blood pressures showed no association

with dietary sodium intake. Because this was the only positive finding of

the INTERSALT study they asked if an independent expert could analyze all

the data, especially since this was a research project that had been funded

by taxpayer money. The study authors refused claiming proprietary ownership

and that this was only the first in a series of papers. It would also

reveal confidential information about the study participants which, under

INTERSALT's policies and alleged federal regulations, they were " obligated

to protect from disclosure. "

 

The NIH, which funded the study, was also petitioned but said that the

financial arrangement had been structured specifically to exclude them from

access to the raw data. This seemed strange. Sensing that some significant

information was being withheld and mindful of the old saying that " the

devil is in the data " , the Salt Institute refused to be stymied. They asked

the ORI (Office of Research Integrity) to determine whether the authors'

findings had been fairly reported. ORI claimed they could only proceed if

it was claimed that the authors had committed fraud - a Catch-22 situation,

since it was impossible to make such an accusation without access to the

raw data.

 

The Salt Institute then sought legal relief. The law requires that all

federal guidelines affecting the public must be written and promulgated

according to the Government Code. This mandates open meetings and

discussions and that the final rules or guidelines must be published in the

Federal Register. It took three years for their attorneys to finally obtain

the raw data dealing with just one of several specific questions that had

been posed. This was enough to bring down the house of cards. A detailed

explanation of how the data had been manipulated to support predetermined

conclusions was published in the British Medical Journal in 1996 and was

subsequently endorsed by various authorities.

 

The NIH has consistently circumvented the Government Code with its

cholesterol and hypertension guidelines by claiming they were written by

outside experts not subject to these regulations, even though they are

presented as official policy. The National Heart, Lung and Blood Institute,

Department of Health and Human Services and U.S. Department of Agriculture

have repeatedly referenced the INTERSALT study as justifying sodium

restriction. The FDA even authorized a " sodium and hypertension " food label

health warning that states, " The INTERSALT study reported a statistically

significant relationship between sodium intake and the slope of systolic

and diastolic blood pressure with age. " How can anyone claim that this is

not official policy?

 

In 1998, Congress mandated that federal agencies make available to the

public all such data by broadening the Freedom of Information Act. It also

included other provisions for the Office of Management and Budget to

require all federal agencies to adhere to this new access-to-data standard.

Unfortunately, this is not retroactive. Fifteen years later we still do not

have access to all the INTERSALT data and hundreds of studies started prior

to 1998 are also exempt. Last month, a congressional bill was introduced

mandating that the results of the more than $45 billion spent annually for

research should be freely available to taxpayers. It would also prohibit

all scientists who receive federal funding from holding copyright to their

research. Don't hold your breath waiting for this bill to become law.

 

The DASH Study-Déja Vu All Over Again?

 

The NIH funded DASH (Dietary Approaches to Stop Hypertension) study

reported in 1997 that blood pressure could be significantly reduced by

eating a diet rich in fruits, vegetables and low-fat dairy products. This

DASH combination diet was more effective than a typical American high fat,

low fiber, low mineral diet and even one of fruits and vegetables,

particularly in people with elevated blood pressures. All three diets had

the same sodium content and there was no attempt to restrict salt.

Government officials were anxious to show that restricting sodium would

lower blood pressure even more.

 

This seemed to be confirmed in a follow-up DASH-Sodium study in 412

subjects with elevated and normal blood pressures that were randomly

assigned to follow the DASH diet or a control typical American diet. The

two groups were further divided into three categories: those who ate 3.3

grams of sodium/day (the amount in the average American diet); 2.4

grams/per day (the current recommended level); and 1.5 grams/day.

Researchers reported in May 2000 that reducing sodium intake from the high

to low levels resulted in an average progressive lowering of systolic blood

pressure of 6.7 mm Hg for those on the control diet and drop of 3 mm Hg for

Dash Diet subjects. Hypertensive patients showed a greater response to a

low sodium diet in both groups, with an impressive 11.5 mm Hg reduction for

those on the control diet. Thus, sodium restriction lowered blood pressure

in hypertensive and nonhypertensive men and women regardless of race. The

belief that, " the lower the blood pressure the better " , prompted the NHLBI

director to declare that the four-decade-old controversy was now over.

Everyone should adhere to a low sodium diet.

 

Not everyone agreed. The DASH diet was rich in calcium, potassium, and

magnesium, all of which have been found to lower blood pressure. The study

group was not representative of the American public and all meals had been

prepared rather than selected. The available statistics suggested that for

those on the DASH diet with normal blood pressures, cutting salt intake in

half had little effect.

 

Diet was the most important influence and there was no significant

additional benefit in hypertensives who also restricted salt. Participants

were only followed for a month and prior studies had shown that any blood

pressure reductions associated with restricting sodium tend to disappear

after 6 months as compensatory mechanisms kick in. Since all subjects were

fed prepared meals there was over 95% compliance, which would be difficult

to achieve in a real life setting where people choose the foods they want

to eat. Almost 60% of the subjects were African Americans and over 40% were

hypertensive. Both of these groups tend to be salt sensitive and are hardly

representative of the general population.

 

David McCarron, a hypertension specialist argued that the figures suggested

that no benefits would be seen in white men under the age of 45, but here

again, all the data were not available. As in the past, requests to release

all the data were denied. McCarron complained about this in a letter to The

New England Journal of Medicine and in a January editorial in the American

Journal of Hypertension, which stated " critical data from a federally

sponsored trial have been withheld. " Nothing happened. On May 15, the Salt

Institute and the U.S. Chamber of Commerce sought legal relief by invoking

the Data Quality Act that took effect last October. This regulation now

mandates that official agencies promulgating " influential " results that

affect large groups must provide enough data and methods for a " qualified

member of the public " to conduct a reanalysis. Since NHLBI's latest sodium

restriction recommendations clearly affect a very large group of people and

are based on the DASH-Sodium study, the argument that all subgroup data

should be made available seems quite valid.

 

DASH authors will probably argue that they plan to publish more papers and,

as noted in a response to McCarron's editorial, they are concerned that he

will " dredge the data " and perform statistical analyses on groups that are

too small to be meaningful. NHLBI has 60 days to respond but based on past

experience, will likely continue to sidestep federal regulations and

stonewall concerned scientists.

 

Should You Avoid Salt? Which Of Some 100 Blood Pressure Pills Is The Best

For You?

 

What's the bottom line? Sodium restriction can benefit certain salt

sensitive hypertensive patients and might possibly delay the development of

high blood pressure in others. However, this does not apply to the general

population, where no study has ever found an association between low-sodium

diets and a reduced incidence of cardiovascular or other diseases. Average

results from large study groups are not a useful guide to determine optimal

treatment for a particular patient. A low fat diet can elevate cholesterol

in some even though a mean decrease may occur in a population. An

eight-year study of New York hypertensives found that those on low-salt

diets had more than four times as many heart attacks as controls with

normal sodium intake.

 

Unfortunately, there is no simple way to determine whether you are " salt

sensitive " other than to go on a high sodium diet for a few weeks and then

a low sodium diet to determine whether there is a significant change in

blood pressure. The NIH recently invited applications for grants to develop

an easily administered screening test for salt sensitivity. Several

molecular markers have been proposed and Tulane researchers received a $6.5

million grant to identify genes that might be associated with

salt-sensitive hypertension, but a simple and accurate test seems a long

way off. The health consequences of salt sensitivity may not be limited to

effects on blood pressure. One study showed a link with increased insulin

resistance and another found that salt sensitivity increased mortality

rates regardless of whether or not it was associated with hypertension.

 

There is growing recognition that hypertension is a complex metabolic

disorder and that treatment efforts must be personalized and directed

towards reducing its complications. This is quite different than simply

attempting to lower elevated pressures to an arbitrary value based on

large-scale study results. A good example is the ALLHAT trial, which

concluded that the normal range for blood pressure should be lowered and a

thiazide diuretic should be first line therapy for all hypertensives. There

is good reason to believe that this could increase cardiovascular and other

complications like diabetes. Some take the view that since most

hypertensives usually require more than one type of medication, a shotgun

approach using minimal doses of diuretics, beta-blockers, calcium channel

antagonists or drugs that affect the renin-angiotensin-aldosterone system

is more practical. In contrast, others believe that 60% of hypertensives

can be controlled on one drug and most others on two.

 

John Laragh proposes that there are basically two types of essential

hypertension: those that are low renin and salt sensitive (30%-35%) that

respond to antivolume drugs like diuretics, and renin mediated hypertension

(60-65%), which can now be treated with one of several antirenin

medications based on renin profiling. The PRA (plasma renin activity) assay

he and Sealey developed decades ago was very sensitive and labor intensive.

The " Laragh Method " that now uses an automated and widely available direct

renin assay seems to be the most logical approach to treat hypertension and

reduce its complications.

 

Stay tuned for more on this!