The relation between salt intake and high blood pressure has been widely recognized, but its exact mechanisms and the reason of such a relation are not clearly understood. In this review, I discuss the sequence of factors relevant to our understanding of the pathophysiology of ‘essential’ hypertension. I will first consider the relation between two major determinants of systemic blood pressure, i.e. extracellular fluid volume (ECFV) and the renin-angiotensin-aldosterone system, and then the renal sensing mechanism of changes in ECFV, the historical background of salt intake in our culture, and finally suggest explanations of results of genetic analyses of hypertension. The discussion is aimed at furthering our understanding of how and why hypertension develops in response to present day high salt intakes. In addition, data are presented for the implementation of a practical health care policy to effectively reduce the incidence of hypertension.

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