Dietary salt reduction and exercise are lifestyle modifications for salt-sensitive hypertensives. While exercise has prominent metabolic effects, salt has an adverse effect on metabolic syndrome, of which hypertension is a hallmark. We hypothesized that dietary salt impacts metabolism in a salt-sensitive model of hypertension.

An untargeted metabolomic approach demonstrates lower circulating levels of the ketone body, beta-hydroxybutyrate (BHB), in high salt-fed hypertensive rats. Despite the high salt intake, specific rescue of BHB levels by nutritional supplementation of its precursor, 1,3-butanediol, attenuates hypertension and protects kidney function. 

This beneficial effect of BHB was likely independent of gut-microbiotal and Th17-mediated effects of salt and instead facilitated by BHB inhibiting the renal Nlrp3 inflammasome.

The juxtaposed effects of dietary salt and exercise on salt-sensitive hypertension, which decrease and increase BHB respectively, indicate that nutritional supplementation of a precursor of BHB provides a similar benefit to salt-sensitive hypertension as exercise.