ESC Congress 2026 Abstract · Oct 26, 2026

Sodium intake, metabolic profile, and target-organ damage in patients with apparently treatment-resistant hypertension

By Bortolotto L, Martins RD, Calil JVBPF et al.

Introduction: The concept of apparently treatment-resistant hypertension (aTRH) has been widely adopted, due to difficulties recognizing true resistant hypertension. Excessive sodium intake plays a relevant role in the pathophysiology of aTRH and cardiometabolic disorders beyond its pressor effects. Objective: To evaluate the association between sodium intake, metabolic profile, and target-organ damage in patients with aTRH. Methods: Retrospective study including patients with aTRH treated at a tertiary hospital followed for a median of 6.4 ± 2 years. Daily sodium intake was estimated by 24-hour urinary sodium excretion [formula: (NaUr/1000) × 58.4]. Associations between sodium intake categories and clinical, metabolic, and echocardiographic data were analyzed using correlation analyses and regression models. Results: A total of 453 patients with aTRH were analyzed (mean age 52.5±11 years; 58.5% women). The mean estimated sodium intake was 10.7±5 g/day, and only 19.2% had an intake <5 g/day. Sodium intake was significantly higher in men and in obese individuals. Patients in the highest intake quartile (>13.5 g/day) were younger and had higher body weight and BMI, higher triglyceride levels, and a larger left ventricular diastolic diameter compared with those with lower intake (<6.9 g/day), with no significant differences in blood pressure levels or number of antihypertensive drugs. Notably, these associations were observed despite similar blood pressure levels across sodium intake categories. Sodium intake correlated inversely with age (r = −0.136; p<0.01) and directly with duration of hypertension (r = 0.119; p=0.01), BMI (r = 0.134; p<0.01), triglycerides (r = 0.129; p<0.01), and left ventricular diastolic diameter (r = 0.164; p<0.01). In multivariable models adjusted for age, sex, BMI, blood pressure, and drug burden, higher sodium intake remained independently associated with BMI, triglycerides, and left ventricular remodeling. Conclusion: In patients with aTRH, higher sodium intake was associated with an adverse metabolic profile and greater left ventricular remodeling, beyond its effects on blood pressure. These findings suggest that sodium intake may constitute a marker of cardiometabolic risk and target-organ damage in this population.

doi.org/10.1093/eurheartj/ehag785.3084Open accessPopulations