The effect of
salt on blood pressure (BP) is controversial. A more important question is whether
salt can produce cardiac target-organ damage, irrespective of its effect on BP. We assessed the effect of
salt with
fludrocortisone on QT dispersion and echocardiographic left ventricular diastolic function in a prospective interventional study involving 29 hypertensive subjects with a raised
aldosterone/
renin ratio who were hospitalized for investigation of possible primary
aldosteronism. Each subject over 4 days was given a total of 28.8 g (480 mmol) of
sodium chloride and 1.5 mg of
fludrocortisone with
potassium supplementation. Baseline and posttreatment 12-lead ECGs and echocardiograms were obtained. There were no significant changes in
body weight, pulse rate, or BP
after treatment with
salt and
fludrocortisone. Plasma
sodium was significantly increased from 141.4 (SD 2.1) to 142.6 (SD 2.4) mmol/L (P:=0.001). QT and QTc dispersion both significantly increased: +19.6 (SD 16.5) ms (95% CI, 13.4 to 25.9) (P:<0.001) and +19.8 (SD 20.9) ms (95% CI, 11.8 to 27.7) (P:<0.001), respectively. There were no significant changes in (n=15) left ventricular dimensions or systolic function, but all diastolic filling indexes, including the preload-independent index, flow propagation velocity (55.49 [SD 10.91] to 48.96 [SD 11.40] cm/s, P:=0.018) worsened, suggesting significant deterioration of left ventricular diastolic function with
salt and
fludrocortisone. In conclusion, a combination of
salt with
fludrocortisone increased QT dispersion and impaired left ventricular diastolic relaxation in hypertensive patients with high
aldosterone/
renin ratios. This raises the possibility that
salt may have BP-independent adverse cardiac effects in susceptible hypertensive subjects.