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Is Sodium Retention a Major Feature of Treatment-Resistant Hypertension?
Yes. Many patients with treatment-resistant hypertension have salt-sensitive hypertension, a condition in which increased sodium intake results in increased blood pressure through sodium and water retention. This process occurs because of activation of the sympathetic nervous system that impairs the suppression of the renin–angiotensin–aldosterone system; consequently, levels of aldosterone increase ([Figure 1][13]). Aldosterone increases sodium reabsorption and thus passive water reabsorption across the distal tubule of the nephron, thereby contributing to hypertension. Although a decrease in salt intake may reduce blood pressure, it is usually insufficient to achieve normotension.