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Cited by 620Sodium Intake and HealthBlood Pressure and Hypertension StudiesRenin-Angiotensin System Studies

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride

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Graudal, Niels Albert, Hubeck-Graudal, Thorbjorn, Jurgens, Gesche·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004022.pub4PMC PMC6478144
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Abstract

BACKGROUND: In spite of more than 100 years of investigations the question of whether a reduced sodium intake improves health is still unsolved. OBJECTIVES: To estimate the effects of low sodium intake versus high sodium intake on systolic and diastolic blood pressure (SBP and DBP), plasma or serum levels of renin, aldosterone, catecholamines, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to March 2016: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 3), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the reference lists of relevant articles. SELECTION CRITERIA: Studies randomising persons to low-sodium and high-sodium diets were included if they evaluated at least one of the above outcome parameters. DATA COLLECTION AND ANALYSIS: Two review authors independently collected data, which were analysed with Review Manager 5.3. MAIN RESULTS: A total of 185 studies were included. The average sodium intake was reduced from 201 mmol/day (corresponding to high usual level) to 66 mmol/day (corresponding to the recommended level).The effect of sodium reduction on blood pressure (BP) was as follows: white people with normotension: SBP: mean difference (MD) -1.09 mmHg (95% confidence interval (CI): -1.63 to -0.56; P = 0.0001); 89 studies, 8569 participants; DBP: + 0.03 mmHg (MD 95% CI: -0.37 to 0.43; P = 0.89); 90 studies, 8833 participants. High-quality evidence. Black people with normotension: SBP: MD -4.02 mmHg (95% CI:-7.37 to -0.68; P = 0.002); seven studies, 506 participants; DBP: MD -2.01 mmHg (95% CI:-4.37 to 0.35; P = 0.09); seven studies, 506 participants. Moderate-quality evidence. Asian people with normotension: SBP: MD -0.72 mmHg (95% CI: -3.86 to 2.41; P = 0.65); DBP: MD -1.63 mmHg (95% CI:-3.35 to 0.08; P =0.06); three studies, 393 participants. Moderate-quality evidence.White people with hypertension: SBP: MD -5.51 mmHg (95% CI: -6.45 to -4.57; P < 0.00001); 84 studies, 5925 participants; DBP: MD -2.88 mmHg (95% CI: -3.44 to -2.32; P < 0.00001); 85 studies, 6001 participants. High-quality evidence. Black people with hypertension: SBP MD -6.64 mmHg (95% CI:-9.00 to -4.27; P = 0.00001); eight studies, 619 participants; DBP -2.91 mmHg (95% CI:-4.52, -1.30; P = 0.0004); eight studies, 619 participants. Moderate-quality evidence. Asian people with hypertension: SBP: MD -7.75 mmHg (95% CI:-11,44 to -4.07; P < 0.0001) nine studies, 501 participants; DBP: MD -2.68 mmHg (95% CI: -4.21 to -1.15; P = 0.0006). Moderate-quality evidence.In plasma or serum, there was a significant increase in renin (P < 0.00001), aldosterone (P < 0.00001), noradrenaline (P < 0.00001), adrenaline (P < 0.03), cholesterol (P < 0.0005) and triglyceride (P < 0.0006) with low sodium intake as compared with high sodium intake. All effects were stable in 125 study populations with a sodium intake below 250 mmol/day and a sodium reduction intervention of at least one week. AUTHORS' CONCLUSIONS: Sodium reduction from an average high usual sodium intake level (201 mmol/day) to an average level of 66 mmol/day, which is below the recommended upper level of 100 mmol/day (5.8 g salt), resulted in a decrease in SBP/DBP of 1/0 mmHg in white participants with normotension and a decrease in SBP/DBP of 5.5/2.9 mmHg in white participants with hypertension. A few studies showed that these effects in black and Asian populations were greater. The effects on hormones and lipids were similar in people with normotension and hypertension. Renin increased 1.60 ng/mL/hour (55%); aldosterone increased 97.81 pg/mL (127%); adrenalin increased 7.55 pg/mL (14%); noradrenalin increased 63.56 pg/mL: (27%); cholesterol increased 5.59 mg/dL (2.9%); triglyceride increased 7.04 mg/dL (6.3%).

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  • Reduced dietary sodium and the DASH diet are associated with significantly lower systolic blood pressure, with the DASH diet having a greater effect on blood pressure reduction.

    “reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet are”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [157]

    The Discussion (Summary of main results; page unavailable) reports lower systolic blood pressure with sodium reduction, particularly in hypertensive study populations. The paper mentions DASH 2001 but does not report that the DASH diet lowers blood pressure more than sodium reduction; it instead questions that study’s control diet. (LLM, conf=0.86)

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  1. Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 12. [DOI: 10.1002/14651858.CD009217.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  2. Alderman MH, Cohen H, Madhavan S. Dietary sodium intake andmortality: the National Health and Nutrition Examination Survey (NHANES I). Lancet 1998;351:781‐5. [DOI] [PubMed] [Google Scholar]
  3. Alderman MH. Reducing dietary sodium: the case for caution. JAMA 2010;303(5):448‐9. [DOI] [PubMed] [Google Scholar]
  4. Ambard L, Beaujard E. Causes of arterial hypertension [Causes de l'hypertension artérielle]. Archives of General Medicine 1904;81:520–33. [Google Scholar]
  5. Bayer R, Johns DM, Galea S. Salt and public health: contested science and the challenge of evidence‐based decision making. Health Affairs 2012;31(12):2738‐46. [DOI] [PubMed] [Google Scholar]
  6. Brunner HR, Laragh JH, Baer L, Newton MA, Goodwin FT, Krakoff LR, et al. Essential hypertension: renin and aldosterone, heart attack and stroke. New England Journal of Medicine 1972;286(9):441‐9. [DOI] [PubMed] [Google Scholar]
  7. Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta‐analyses. BMJ 2016;352:i717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chapmann CP, Gibbons TB. The diet and hypertension. A review. Medicine 1949;29:29‐69. [DOI] [PubMed] [Google Scholar]
  9. Cobb LK, Anderson CA, Elliott P, Hu FB, Liu K, Neaton JD, et al. American Heart Association Council on Lifestyle and Metabolic Health. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation 2014;129(10):1173‐86. [DOI] [PubMed] [Google Scholar]
  10. Cohen HW, Hailpern SM, Fang J, Alderman MH. Sodium intake and mortality in the NHANES II follow‐up study. American Journal of Medicine 2006;119(3):275.e7‐14. [DOI] [PubMed] [Google Scholar]
  11. Cohen HW, Hailpern SM, Alderman MH. Sodium intake and mortality follow‐up in the Third National Health and Nutrition Examination Survey (NHANES III). Jornal of General Internal Medicine 2008;23(9):1297‐1302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, et al. Blood pressure, stroke and coronary heart disease. Part 2, short term reductions in blood pressure; overview of randomised drug trials in their epidemiological context. Lancet 1990;335(8693):827‐38. [DOI] [PubMed] [Google Scholar]
  13. Cutler JA, Follmann D, Elliot P, Suh I. An overveiw of randomised trials of sodium reduction and blood pressure. Hypertension 1991;17 (suppl 1):I27‐33. [DOI] [PubMed] [Google Scholar]
  14. Cutler JA, Follmann D, Allender PS. Randomized trials of sodium reduction: an overview. American Journal of Clinical Nutrition 1997;65(2 Suppl):643S‐651S. [DOI] [PubMed] [Google Scholar]
  15. Ebrahim S, Smith GD. Lowering blood pressure: a systematic review of sustained effects of non‐pharmacological interventions. Journal of Public Health Medicine 1998;20(4):441‐8. [DOI] [PubMed] [Google Scholar]
  16. Folkow B. On bias in medical research; reflections on present salt‐cholesterol controversies. Scandinavian Cardiovascular Journal 2011;45(4):194‐7. [DOI] [PubMed] [Google Scholar]
  17. Freedman DA, Petitti DB. Salt and blood pressure: conventional wisdom reconsidered. Evaluation Review 2001;25(3):267‐87. [DOI] [PubMed] [Google Scholar]
  18. Frieden TR. Sodium reduction‐saving lives by putting choice into consumers hands. JAMA 2016;316(6):579‐80. [DOI] [PubMed] [Google Scholar]
  19. Gardener H, Rundek T, Wright CB, Elkind MS, Sacco RL. Dietary sodium and risk of stroke in the Northern Manhattan study. Stroke 2012;43:1200‐5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Geerling JC, Loewy AD. Central regulation of sodium appetite. Experimental Physiology 2008;93(2):177‐209. [DOI] [PubMed] [Google Scholar]
  21. Geleijnse JM, Witteman JC, Stijnen T, Kloos MW, Hofman A, Grobbee DE. Sodium and potassium intake and risk of cardiovascular eventsand all‐cause mortality: the Rotterdam Study. European Journal of Epidemiology 2007;22(11):763‐70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Goff DC, Howard G, Russel GB, Labarthe DR. Birth cohort evidence of population influences on blood pressure in the United states 1887‐1994. Annals of Epidemiology 2001;11(4):271‐9. [DOI] [PubMed] [Google Scholar]
  23. Graudal N. A radical sodium reduction policy is not supported by randomized controlled trials or observational studies: grading the evidence. American Journal of Hypertension 2016;Jan 27 Epub ahead of print:1‐6. [DOI] [PubMed] [Google Scholar]
  24. Graudal NA, Hubeck‐Graudal T, Jürgens G. Reduced dietary sodium intake increases heart rate. a meta‐analysis of 63 randomized controlled trials including 72 study populations. Front Physiology 2016;7:111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Graudal N. Con: Reducing salt intake at the population level: is it really a public health priority?. Nephrology Dialysis Transplantation 2016;pii: gfw280. [Epub ahead of print]:1‐6. [DOI] [PubMed] [Google Scholar]
  26. Graudal N. Commentary: Possible role of salt intake in the development of essential hypertension. International Journal of Epidemiology 2005;34(5):972‐4. [DOI] [PubMed] [Google Scholar]
  27. Graudal NA, Hubeck‐Graudal T, Jurgens G, McCarron DA. The significance of duration and dose of sodium reduction intervention in normotensive and hypertensive individuals. A meta‐analysis. Advances in Nutrition 2015;6(2):169‐77. [DOI] [PMC free article] [PubMed] [Google Scholar]

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Authors
Graudal, N. A., Hubeck-Graudal, T., & Jurgens, G.
Affiliations
  • Copenhagen University Hospital (DK)
  • Herning Hospital; Department of Nuclear Medicine; Herning Denmark
  • Roskilde Hospital; Clinical Pharmacology Unit; Roskilde Denmark
ORCID
Graudal, Niels Albert
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-04-09
Volume
12
Pages
CD004022-CD004022
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004022.pub4
PMC
PMC6478144
OpenAlex
W1953196136
Cited by
620
References
16
Citations by year
2026: 3 · 2025: 19 · 2024: 24 · 2023: 41 · 2022: 44 · 2021: 63 · 2020: 59 · 2019: 50 · 2018: 42 · 2017: 26 · 2016: 31 · 2015: 47 · 2014: 42 · 2013: 36 · 2012: 23
FWCI
4.98
Type
journal article
Language
en
Update notices
new_version (2020-12-12)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (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 › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords
sodium restriction, high sodium intake, dietary sodium reduction, blood pressure, renin, aldosterone, catecholamines, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, hypertension, normotensive subjects, racial differences, cardiovascular risk factors, randomized controlled trials, meta-analysis of trials, cardiovascular disease prevention, stroke prevention, cardiovascular mortality, cost-effectiveness
MeSH terms
Aldosterone, Blood Pressure, Catecholamines, Cholesterol, Diet, Sodium-Restricted, Epinephrine, Humans, Hypertension, Norepinephrine, Renin, Triglycerides, Randomized Controlled Trials as Topic, Sodium Chloride, Dietary, Black People, White People, Asian People, Recommended Dietary Allowances

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