Table 4

A proposed practice pattern if pharmaconutrigenetics was incorporated in patient care

PopulationDaily sodium targets for adultsGenetic variants to testRecommendations
General population1.6–2.5 g (UK).
1.5–2.3 g (USA).		Salt sensitivity variants (table 3)49–53

  • Ensure sodium intake is between the AI/RNI and the UL.4 10 13 14

  • Assess genetic variants for salt sensitivity.

  • Salt - sensitive individuals: it may be beneficial to reduce sodium levels closer to the AI/RNI than UL.*34

  • Salt - resistant individuals: ensure sodium intake is below the UL.

Newly diagnosed with hypertension requiring pharmacological agents1.6–2.5 g (UK).
1.5–2.3 g (USA).		Salt-sensitivity variants (table 3).49–53
Response to antihypertensive agent variants (online supplementary table 1).51 53 63–70
Resistant hypertension variants and response to antihypertensive agents (online supplementary table 2).

  • Assess genetic variants for salt sensitivity, antihypertensive agent selection and resistant hypertension/response to antihypertensive agents.*63 72

  • Salt - sensitive individuals: reduce sodium intake down towards AI/RNI with priority, along with other lifestyle changes.*34

  • Salt - resistant individuals: reduce sodium down below UL and focus on dietary factors besides sodium intake and other lifestyle factors.*34

Resistant and refractory hypertension1.6–2.5 g (UK).
1.5–2.3 g (USA).		Salt-sensitivity variants (table 3).49–53
Response to antihypertensive agent variants (online supplementary table 1).51 53 63–70
Resistant hypertension variants and response to antihypertensive agents (online supplementary table 2).

  • Assess genetic variants for salt sensitivity, antihypertensive agent selection and resistant hypertension/response to antihypertensive agents.*63 72

  • Salt - sensitive individuals: reduce sodium intake down towards AI/RNI with high priority, along with other lifestyle changes.*34

  • Salt - resistant individuals: reduce sodium down below UL and focus on dietary factors besides sodium intake and other lifestyle factors to manage blood pressure.*34

  • *The proposed recommendation has not been clinically validated and presents as a potential way for precision medicine to be incorporated into patient care. Promising evidence for future incorporation into recommendations is cited.

  • AI, adequate intake.