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Cited by 569Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

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Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion

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Stolarz-Skrzypek, Katarzyna·2011·JAMA
DOI 10.1001/jama.2011.574
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Abstract

CONTEXT: Extrapolations from observational studies and short-term intervention trials suggest that population-wide moderation of salt intake might reduce cardiovascular events. OBJECTIVE: To assess whether 24-hour urinary sodium excretion predicts blood pressure (BP) and health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Prospective population study, involving 3681 participants without cardiovascular disease (CVD) who are members of families that were randomly enrolled in the Flemish Study on Genes, Environment, and Health Outcomes (1985-2004) or in the European Project on Genes in Hypertension (1999-2001). Of 3681 participants without CVD, 2096 were normotensive at baseline and 1499 had BP and sodium excretion measured at baseline and last follow-up (2005-2008). MAIN OUTCOME MEASURES: Incidence of mortality and morbidity and association between changes in BP and sodium excretion. Multivariable-adjusted hazard ratios (HRs) express the risk in tertiles of sodium excretion relative to average risk in the whole study population. RESULTS: Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion, from 50 deaths in the low (mean, 107 mmol), 24 in the medium (mean, 168 mmol), and 10 in the high excretion group (mean, 260 mmol; P < .001), resulting in respective death rates of 4.1% (95% confidence interval [CI], 3.5%-4.7%), 1.9% (95% CI, 1.5%-2.3%), and 0.8% (95% CI, 0.5%-1.1%). In multivariable-adjusted analyses, this inverse association retained significance (P = .02): the HR in the low tertile was 1.56 (95% CI, 1.02-2.36; P = .04). Baseline sodium excretion predicted neither total mortality (P = .10) nor fatal combined with nonfatal CVD events (P = .55). Among 2096 participants followed up for 6.5 years, the risk of hypertension did not increase across increasing tertiles (P = .93). Incident hypertension was 187 (27.0%; HR, 1.00; 95% CI, 0.87-1.16) in the low, 190 (26.6%; HR, 1.02; 95% CI, 0.89-1.16) in the medium, and 175 (25.4%; HR, 0.98; 95% CI, 0.86-1.12) in the high sodium excretion group. In 1499 participants followed up for 6.1 years, systolic blood pressure increased by 0.37 mm Hg per year (P < .001), whereas sodium excretion did not change (-0.45 mmol per year, P = .15). However, in multivariable-adjusted analyses, a 100-mmol increase in sodium excretion was associated with 1.71 mm Hg increase in systolic blood pressure (P.<001) but no change in diastolic BP. CONCLUSIONS: In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality.

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  1. [10]10. World Medical Association Declaration of Helsinki. World Medical Association declaration of Helsinki. Rec- ommendations guiding physicians in biomedical re- search involving human subjects. JAMA. 1997; 277(11):925-926.

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Metadata

Authors
Stolarz-Skrzypek, K.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2011-05-04
Volume
305
Issue
17
Pages
1777
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2011.574
OpenAlex
W2150639294
Semantic Scholar
84e0ae286140da2dedb378747cffa269ad57d3f7
Cited by
569
References
49
Citations by year
2026: 11 · 2025: 16 · 2024: 14 · 2023: 24 · 2022: 21 · 2021: 28 · 2020: 43 · 2019: 25 · 2018: 35 · 2017: 28 · 2016: 42 · 2015: 58 · 2014: 61 · 2013: 60 · 2012: 71
FWCI
66.25
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
sodium excretion, salt intake, blood pressure, hypertension incidence, cardiovascular mortality, cardiovascular morbidity, salt reduction, normotensive subjects, salt sensitivity, cardiovascular risk prediction
MeSH terms
Adult, Aged, Belgium, Blood Pressure, Cardiovascular Diseases, Diet, Sodium-Restricted, Female, Humans, Hypertension, Male, Middle Aged, Mortality, Predictive Value of Tests, Prospective Studies, Sodium, Sodium, Dietary, Incidence, Young Adult

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