Reducing food salt content – a neglected approach to hypertension prevention and treatment in the population

Česká verzia

Authors: K. Horký
Authors place of work: II. interní klinika kardiologie a angiologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc.
Published in the journal: Vnitř Lék 2009; 55(9): 797-801
Category: 80th Birthday - prof. MUDr. Miloš Štejfa, DrSc., FESC

Summary

Long-term dietary salt supply, disproportional to the high metabolic requirements, plays an important role in pathogenesis of arterial hypertension. BP, its rise with age and hypertension prevalence in the population are directly proportional to sodium supply. Consistent effect of salt supply on the BP values is documented from observational as well as randomised controlled studies. It is, therefore, possible to assume that decrease in salt intake in the population could positively affect population BP mean, age-related increase in BP as well as a range of cardiovascular complications of hypertension and could thus contribute to improving the course and prognosis of this “non-infectious epidemy”, the incidence of which exceeds 30% in the adult population and increases continually with age. Based on a review of published population-based observations and clinical studies, the paper summarizes briefly the opinions on the impact of the sodium chloride dietary intake modifications on BP, outcomes of these modifications within various historical, ethnic, experimental and clinical contexts, impact on BP morbidity and mortality, population-based importance of the current high salt supply decrease on these indicators and possible utilization in the primary prevention of hypertension.

Key words:
dietary sodium supply – pathogenesis of essential hypertension – BP rise with age – hypertension complications – options for primary prevention of hypertension

Zdroje

1. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009; 23: 363–384.

2. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens 1992; 6: 23–25.

3. Alam S, Johnson AG. A meta-analysis of randomized controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure. J Hum Hypertens 2006; 13: 367–374.

4. Cook NR. Salt intake, blood pressure and clinical outcomes. Curr Opin Nephrol Hypertens 2008; 17: 310–314.

5. World Health Report 2002. Reducing risks, promoting healthy life. World Health Organisation. Geneva, 2002. Available from: http://www.who.int/whr/2002.

6. Geleijnse JM, Hofman A, Witteman JC et al. Long term effects of neonatal sodium reduction on incidence of hypertension. Hypertension 1997; 29: 913–917.

7. Dumler F. Dietary sodium intake and arterial blood pressure. J Ren Nutr 2009; 19: 57–60.

8. Kupari M, Koskinen P, Virolainen J. Correlates of left ventricular mass in population sample aged 36–37 years. Focus on lifestyle and salt intake. Circulation 1994; 89: 1041–1050.

9. Nedbálková M, Souček M. Hypertenze u dialyzovaných nemocných. Vnitř Lék 2008; 54: 827–834.

10. Verhave JC, Hillege HL, Burgerhof JG et al. Sodium intake affects urinary albumin excretion especially in overweight subjects. J Intern Med 2004; 256: 324–330.

11. Ritz E, Koleganova N, Piecha G et al. Role of sodium intake in the progression of chronic kidney disease. J Ren Nutr 2009; 19: 61–62.

12. He J, Gu D, Chen J et al. Gender difference in blood pressure response to dietary sodium intervention in the GenSalt study. J Hypertens 2009; 27: 48–54.

13. Chen J, Gu D, Huang J et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary prevention study. Lancet 2009; 373: 829–835.

14. Vollmer WM, Sacks FM, Ard J et al. Effects of diet and sodium intake on blood pressure: Subgroup analysis of the DASH-Sodium Trial. Ann Intern Med 2001; 135: 1019–1028.

15. Armando I, José PA. Sensing salt intake. Hypertension 2009; 53: 118–119.

16. Dickinson BD, Havas S. Council on Science and Public Health AMA. Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the Council on Science and Public Health. Arch Intern Med 2007; 167: 1460–1468.

17. Joossens JV, Hill MJ, Elliott P et al. Dietary salt, nitrate and stomach cancer mortality in 24 countries. European Cancer Prevention (ECP) and the INTERSALT Cooperative Research Group. Int J Epidemiol 1996; 25: 494–504.

18. Adrogue HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. New Engl J Med 2007; 356: 1966–1978.

19. Cook NR, Obarzanek E, Cutler JA et al. Joint effect of sodium and potassium intake on subsequent cardiovascular disease. Arch Intern Med 2009; 169: 32–40.

20. Intersalt Cooperative Research Group. Intersalt an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium excretion. BMJ 1988; 297: 319–328.

21. Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis 2006; 49: 59–75.

22. Forte JG, Miguel JM, Miguel MJ et al. Salt and blood pressure: a community trial. J Hum Hypertens 1989; 3: 179–184.

23. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens 2002; 16: 761–770.

24. Wright JT Jr, Rahman M, Scarpa A et al. Determinants of salt sensitivity in black and white normotensive and hypertensive women. Hypertension 2003; 42: 1087–1092.

25. Bochud M, Staessen JA, Mailard M et al. Ethnic differences in proximal and distal tubular sodium reabsorption are heritable in black and white populations. J Hypertens 2009; 27: 606–612.

26. Sacks FM, Svetkey LP, Vollmer WM et al. Effects on blood pressure of reduce dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3–10.

27. Dickinson BD, Havas S. Reducing the population burden of cardiovascular disease by reducig sodium intake: a report of the Council on Science and Public Health. Arch Intern Med 2007; 167: 1460–1468.

28. He FJ, MacGregor GA. Salt intake and cardiovascular disease. Nephrol Dial Transplant 2008; 23: 3382–3384.

29. Ikeda N, Gakidou E, Hasegawa T et al. Understanding the decline of mean systolic blood pressure in Japan: an analysis of pooled data from the National Nutrition Survey 1986–2002. Bull World Health Organ 2008; 86: 978–988.

30. Laatikainen T, Pietinen P, Valsta L et al. Sodium in the Finnish diet: 20 year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr 2006; 60: 965–970.

31. Tuomilehto J, Jousilahti R, Rastenyte D et al. Urinary sodium excretion and cardiovascular mortality in Finland. Lancet 2001; 357: 848–851.

32. Tunstall-Pedoe H, Woodward M, Tavendale R et al. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study. BMJ 1997; 315: 722–729.

33. Cook NR, Cutler JA, Obarzanek E et al. Long-term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the Trials of Hypertension Prevention (TOHP). BMJ 2007; 334: 885–888.

34. Joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases. Geneva, 28. 1.–1. 2. 2002. Available from: http://www.who.int/hpr/NPH/docs/who fao experts report.pdf.