Salt, Sodium and Hypertension

Hypertension

Arterial hypertension represents one of the most widespread metabolic pathologies, so much so that it reaches a prevalence of 20% (10,000,000 people) in the general Italian population.

Hypertension is a mostly asymptomatic disorder, therefore the diagnosis is usually occasional; due to the reduced tolerance towards dietary therapy, only 1/4 of hypertensive patients manage to maintain blood pressure levels within the limits of good health.
It seems that hypertension is a predominantly multifactorial disorder whose diagnosis can be confirmed by the constancy of blood pressure levels above the norm, specifically higher than:

90 mmHg of minimum pressure, therefore diastolic (more insidious and dangerous!)
140 mmHg of maximum pressure, therefore systolic

Hypertension can also be classified as essential or primary hypertension and secondary hypertension; the first form consists of its own pathological alteration, of which the aggravating variables are known but all the regulatory mechanisms are still unclear. Secondary hypertension, on the other hand, derives from other serious pathologies such as kidney or heart problems (only 5% of cases).
It is possible to define hypertension as a potentially worsening condition with advancing age but easily (theoretically) improved by

specific dietary precautions (low sodium therapy)

increased motor activity

reduction of any overweight

and eventually the adoption of a specific drug therapy.

Sodium in food

The sodium intake is commonly divided into two categories:

DISCRETIONAL: added with the culinary preparation and / or at the table (for example by adding cooking salt)
NON-DISCRETIONAL: already present in foods before home processing or final consumption

Personally, I prefer to evaluate sodium as NATURALLY present and ADDED, as it does not matter as much who or why has carried out the sodium integration to the foods (if the industry for the preparation of preserved foods or the diner), as the fact that this sodium should NOT be added ANYWAY! Also because to tell the truth, in the guidelines for the prevention and treatment of hypertension it is recommended to abolish both foods purchased already salted (sausages, salted meats, salted fish, aged cheeses, canned products and especially those preserved in brine etc) than the homemade addition of cooking salt.
In any case, it seems that the discretionary portion of sodium introduced with the diet represents about 36% of the total intake in Italy, while in rural areas or in any case linked to tradition there is a "further increase of 10% thanks to homemade preserves. What leaves you astonished is that:

the sodium naturally present in food represents only 10% of the total intake.

What remains (about 55%) derives from the "personal addition to the table and from the consumption of industrial or in any case already prepared foods (sausages, cheeses, canned foods, etc., which contain a lot of cooking salt but also a minor part [10%] of other flavor enhancers such as sodium glutamate or sodium bicarbonate).
On the basis of a "large-scale food analysis, it emerged that the vast majority of non-discretionary sodium derives from cereal derivatives (bread and baked goods), followed by meat-fish-eggs, then milk derivatives, etc." reality (in my opinion) this estimate is only partially acceptable since it is NOT weighted and is heavily affected by the importance of consumption frequencies. Cereal derivatives, in Italy, are the group of foods most consumed, therefore logically they bring greater quantities of table salt; in this case it would also seem useful to use bread (or derivatives) not added with table salt.
Every day, on average, an Italian adult ingests about 10g of table salt.

Cooking salt and food education

In order to prevent the onset of hypertension, it is logical that it is advisable to drastically reduce the use of discretionary salt and that of artificial foods containing table salt. However, in the clinic, low-sodium therapy often fails due to unsustainability organoleptic of culinary preparations; hypertensive people are refractory to tasteless foods, therefore therapeutic compliance is heavily affected. The result is that, very often, a drug therapy against hypertension replaces a healthy and correct diet causing a waste of public health money.

Whose fault is it?

Of course far from me create a scapegoat that relieves the final consumer of his responsibilities, indeed! As a health professional I can say that drugs against hypertension should NOT be loanable (except in very rare cases). Hypertension is a pathology that in other countries of the world, where the habit of eating salty is NOT cultivated, a more unique than rare condition appears (see Epidemiology of Japan); moreover, the worst aggravating factor of hypertension is overweight (another condition extremely dependent on personal habits and lifestyle). Why channel energy and resources to maintain the vices and charms of subjects who, due to laziness or lack of willpower, do not engage in treatment? The situation is different in the case of some rare situations in which a SERIOUS genetic predisposition to hypertension, a full-blown psychiatric syndrome or a form of secondary hypertension is identified; in this case, public health intervention would be at least justified and desirable.
However, it is also not possible to relieve public institutions of all responsibility. Although they may appear committed to the prevention and dissemination of correct habits, they too ignore some of the real primary causes of this metabolic pathology. such as sweet and alcohol) is childhood, and however much parents may try to reduce table salt in home meals, both children and adolescents are inevitably "ruined" elsewhere.
This is certainly the case of collective catering in which, alas, when it comes to interests, very little account is taken of food safety (see fast-food); but I would also like (and above all) attention to the automated distribution of snacks. "interior of educational establishments.
After all, how to blame a little boy; in his reduced understanding, he finds himself having to choose between a brioches, a cereal and chocolate bar and a flatbread. Certainly, in his mind the recommendations of his mother echo and continually repeat themselves: "Eat a few sweets!" ... so ... better opt for a flatbread ... or even a packet of crackers, taralli, breadsticks, etc. "They are NOT sweet!"
Unfortunately, as for sweet foods, these snacks also present unhealthy nutritional aspects, as they are distinguished by high amounts of sodium chloride; consuming them habitually, they have a negative influence on the habits of the youngest, strongly predisposing them to the salty taste and consequently to the development of hypertension.
At this point, if one fruit were not enough, it would be better to opt for a sandwich with SWEET raw ham, or with a little stracchino, or with robiola, etc. calories, would contain about half "of sodium.
Preventing the habit of eating salty is the first great rule of prevention against the onset of arterial hypertension.