From the Guidelines
Salt tablets are contraindicated in patients with pulmonary hypertension who have right ventricular overload and fluid retention, and these patients should be counselled to follow a reduced-salt diet. This recommendation is based on the most recent evidence from a 2023 study published in Nature Reviews Rheumatology 1. The study emphasizes the importance of non-pharmacological strategies in managing patients with systemic sclerosis and pulmonary hypertension, including dietary modifications to reduce salt intake.
Key considerations in managing pulmonary hypertension patients include:
- Avoiding smoking tobacco and marijuana
- Receiving routine vaccinations
- Exercising regularly as tolerated
- Discussing contraception
- Using oxygen if hypoxic
- Investigating causes of hypoxia, such as pulmonary veno-occlusive disease, interstitial lung disease, or pulmonary emboli
- Providing support personnel, such as social workers and nurses, and palliative care as needed
In the context of pulmonary hypertension, it is crucial to balance the need for adequate preload and systemic blood pressure against the risks of fluid overload in a compromised cardiopulmonary system. While salt supplementation may be beneficial in certain cases, such as prostacyclin-induced vasodilation with hypotension, the potential risks of worsening edema and increasing right heart workload in patients with right heart failure and fluid retention must be carefully considered. Therefore, the decision to use salt tablets should be made with caution and in consultation with a pulmonary hypertension specialist who can assess the patient's individual condition and monitor their response to treatment 1.
From the Research
Salt Tablets and Pulmonary Hypertension
- There is no direct evidence in the provided studies that salt tablets are contraindicated in pulmonary hypertension.
- However, the studies suggest that managing fluid and salt intake is crucial in preventing volume overload in patients with pulmonary arterial hypertension (PAH) 2, 3.
- Volume overload can lead to right ventricular failure, and healthcare professionals play a key role in monitoring, preventing, and managing volume overload in PAH patients 2.
- Patients with PAH are advised to incorporate dietary restrictions, including limiting salt intake, to prevent volume overload 2, 3.
- The use of diuretics, which can help reduce fluid retention, is a common treatment strategy for PAH, but patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance 2, 3.
- While salt tablets are not explicitly mentioned as a contraindication, the emphasis on managing salt intake and preventing volume overload suggests that excessive salt consumption, including salt tablets, may be harmful for patients with PAH 2, 3.