The role of sodium intake in the development of treatment-resistant hypertension remains uncertain, particularly among African American adults who have a high burden of hypertension.

An analysis from the Jackson Heart Study (JHS), published in the Journal of Human Hypertension, examined the association between 24-hour urinary sodium excretion and incident apparent treatment-resistant hypertension (aTRH) among African American adults with hypertension. The longitudinal cohort included 5306 individuals, of whom 452 participants with baseline hypertension and complete urinary sodium and medication data were analyzed.

Participants had a mean age of 63 years, and 27.7% were men. Sodium excretion was categorized into quartiles: Q1 (253–2530 mg/day), Q2 (2553–3657 mg/day), Q3 (3680–4692 mg/day), and Q4 (4715–9775 mg/day). Over a median follow-up of 7.5 years, 123 participants (27.2%) developed aTRH. Incidence rates were 25.7%, 24.8%, 29.2%, and 29.2% across quartiles.

In adjusted models using a semi-parametric proportional hazards approach, urinary sodium excretion was not associated with incident aTRH. Hazard ratios were 0.71 (95% confidence interval [CI] 0.34–1.46) for Q2, 1.02 (95% CI 0.50–2.06) for Q3, and 0.95 (95% CI 0.46–2.00) for Q4 compared with Q1 (P=0.166).

These findings indicate no statistically significant association between urinary sodium excretion and incident aTRH in this cohort.