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Salt Reduction to Prevent Hypertension and Cardiovascular Disease
Open accessAbstract
There is strong evidence for a causal relationship between salt intake and blood pressure. Randomized trials demonstrate that salt reduction lowers blood pressure in both individuals who are hypertensive and those who are normotensive, additively to antihypertensive treatments. Methodologically robust studies with accurate salt intake assessment have shown that a lower salt intake is associated with a reduced risk of cardiovascular disease, all-cause mortality, and other conditions, such as kidney disease, stomach cancer, and osteoporosis. Multiple complex and interconnected physiological mechanisms are implicated, including fluid homeostasis, hormonal and inflammatory mechanisms, as well as more novel pathways such as the immune response and the gut microbiome. High salt intake is a top dietary risk factor. Salt reduction programs are cost-effective and should be implemented or accelerated in all countries. This review provides an update on the evidence relating salt to health, with a particular focus on blood pressure and cardiovascular disease, as well as the potential mechanisms.
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“People with CVD and T2DM are encouraged to reduce sodium intake, as this may reduce systolic BP by, on average, 5.8 mmHg in hypertensive patients and 1.9 mmHg in normotensive patients.94,95”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [95]
In the citing paper
“In a meta-analysis, in hypertensive and normotensive people, reducing salt intake by 2.5 g/day resulted in a 20% relative reduction of ASCVD events.95”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [95]
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“Several efforts have been made in different countries to reduce salt consumption (Ding et al., 2020; Folta et al., 2019; Graça, 2013; He, Tan, Ma, & MacGregor, 2020; Kilcast & Angus, 2007; Santos et al., 2017; Toldrá & Barat, 2012), but despite all these initiatives populations still consume salt…”
Cury, C. M., Banin, V. B., dos Reis, P. F., Caramori, J. C. T., Barretti, P., de Andrade, L. G. M., & Martín, L. C. (2022) · BMC Nephrology · doi:10.1186/s12882-022-02911-7 · Cited by 2
Processing Smoked Pork Loin Using Ultrasound-Assisted Curing
Carnero‐Hernandez, A., Alarcon-Rojo, A. D., Garcia-Galicia, I. A., Aguilar-Palma, G. N., Carrillo-López, L. M., & Huerta‐Jimenez, M. (2023) · Processes · doi:10.3390/pr11010275 · Cited by 2
Los alimentos ultraprocesados como un tema de estudio de la bioética global
Berlanga, G. P. (2023) · Medicina y Ética · doi:10.36105/mye.2023v34n4.02 · Cited by 4
Han, Y., Fan, Z., & Li, T. (2023) · Nutrients · doi:10.3390/nu15204321 · Cited by 2
“There is also research evidence that excessive salt intake can reduce immunity [15] and is associated with an increased risk of diseases, such as osteoporosis, kidney stones [16], and gastric cancer [6].”
BackgroundCieślik, M., Strobel, S. D., Bryniarski, P., Twardowska, H., Chmielowski, A., Rudek, M., Felkle, D., Zięba, K., Kaleta, K., Jarczyński, M., et al. (2024) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2024.116648 · Cited by 2
Salt versus no salt restriction in heart failure a review
Raggi, P. (2024) · European Journal of Clinical Investigation · doi:10.1111/eci.14265 · Cited by 2
Arakawa, K., Tominaga, M., Sakata, S., & Tsuchihashi, T. (2024) · Hypertension Research · doi:10.1038/s41440-024-01945-8 · Cited by 2
Targeting GPR39 in structure-based drug discovery reduces Ang II-induced hypertension
Hua, D., Huang, W., Xie, Q., Xu, W., Tang, L., Liu, M.-W., Wu, X., Zhang, Q., Cao, X., Li, P., et al. (2024) · Communications Biology · doi:10.1038/s42003-024-07132-2 · Cited by 2
Yao, Y., Zhang, Z.-X., Yin, S.-F., Wu, S., & Liu, Z. (2024) · World Journal of Cardiology · doi:10.4330/wjc.v16.i12.731 · Cited by 2
van Damme, I., van Veldhuisen, E. R., Verkaar, A. J. C. F., Bemelmans, R. H. H., Hovens, M. M. C., Visseren, F. L. J., Koopal, C., Winkels, R. M., & Geleijnse, J. M. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.12.020 · Cited by 4
Yin, L., Yu, L., Wang, Y., Li, X., Zhang, F., Zhan, Q., An, Q., Tian, K., Liu, T., & Wang, Z. (2025) · Scientific Reports · doi:10.1038/s41598-025-88101-5 · Cited by 2
Yang, X., Zhang, F., Zhang, B., Qi, H., Xie, Y., Peng, W., Li, B., Wen, F., Li, P., Sun, Y., et al. (2025) · Nutrients · doi:10.3390/nu17071289 · Cited by 2
“Substantial epidemiological evidence has established causal relationships between dietary sodium consumption and blood pressure (BP) regulation [2,3].”
Policy Development in Primary Healthcare in Hong Kong—Building an Effective District Health System
Lee, A. (2025) · Quality of life in Asia · doi:10.1007/978-981-96-0817-1_1 · Cited by 2
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“Another potential explanation may be the effect of a high sodium diet and increasing oxidative stress and causing alterations in the kidney and vascular systems [56, 57].”
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Can these salt substitutes prevent complications of hypertension?
Chang, E. (2023) · The Journal of Family Practice · doi:10.12788/jfp.0667 · Cited by 2
“CONTINUED lower dietary sodium intake.(13) Previous studies have shown that potassium-enriched salt substitutes lower BP, but their impact on CV morbidity and mortality is not well defined.”
BackgroundMethodHigh salt is a risk factor for cardiovascular and kidney diseases. What is next, fibrosis?
Bagrov, A. Y. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002853 · Cited by 2
“This finding has been supported by numerous other large epidemiological studies [2].”
BackgroundResultKouvari, M., Diamantis, D. V., Katsas, K., Radaios, V., Veloudaki, A., & Linos, A. (2023) · Children · doi:10.3390/children10071268 · Cited by 2
“High salt intake in childhood/adulthood predisposes an individual to various long-term aggravating health effects, including elevated blood pressure, CVD, several types of cancer, and respiratory illnesses [39].”
BackgroundKobayashi, S., Amano, H., Terawaki, H., & Kawaguchi, Y. (2024) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2024.08.002 · Cited by 2
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Wang, F., Wei, M., Yang, N., & Wang, X. (2024) · Medicine · doi:10.1097/md.0000000000038676 · Cited by 1
Metadata
- Authors
- He, F. J., Tan, M., Ma, Y., & MacGregor, G. A.
- Affiliations
- Queen Mary University of London (GB)
- Harvard University (US)
- Corresponding author
- He, Feng J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 75
- Issue
- 6
- Pages
- 632-647
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3005813910
- Cited by
- 589
- References
- 182
- Citations by year
- 2026: 71 · 2025: 125 · 2024: 123 · 2023: 86 · 2022: 97 · 2021: 64 · 2020: 22
- FWCI
- 8.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health and Care Research (16/136/77)
- Medical Research Council (MR/P012590/1, MR/J015903/1)
- 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
- salt reduction, dietary sodium, hypertension, blood pressure, cardiovascular disease, all-cause mortality, kidney disease, gastric cancer, osteoporosis, fluid homeostasis, inflammation, gut microbiota, immune response, dietary risk factors, cost-effectiveness
- MeSH terms
- Blood Pressure, Humans, Hypertension, Legislation, Food, Sodium Chloride, Dietary
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