Cited by 589Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

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Salt Reduction to Prevent Hypertension and Cardiovascular Disease

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He, Feng J., Tan, Monique, Ma, Yuan, MacGregor, Graham A.·2020·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2019.11.055

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Abstract

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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“Loss in the kidneys' capacity to eliminate salt loads specifically in older people could cause high blood pressure [20] and may lead to genitourinary problems.”
Background
Habitual salt preference worsens blood pressure in hospitalized hypertensive patients with omicron infection under epidemic-related stress
Wang, C., Tan, W., Liu, X., He, M., Zeng, S., Sun, M., Yan, L., Li, M., Zhan, K., Wang, K., et al. (2024) · BMC Public Health · doi:10.1186/s12889-023-17633-0 · Cited by 1
Low-Chloride Diet Prevents the Development of Arterial Hypertension and Protects Kidney Function in Angiotensin II-Infused Mice
Liberona, J., Araos, P. A., Rodríguez, M., León, P., Stutzin, A., Alzamora, R., & Michea, L. (2024) · Kidney & Blood Pressure Research · doi:10.1159/000535728
High Salt Remodels Kidney Metabolism: Metabolite Fuel, Fate, and Signals
Lassé, M., & Rinschen, M. M. (2024) · Function · doi:10.1093/function/zqae006
Diuretika bei arterieller Hypertonie
Essigke, D. (2024) · Nephrologie aktuell · doi:10.1055/a-2187-3490
Mammalian Cell Models of the Distal Convoluted Tubule: A Systematic Review of Cell Lines, Culture Condition and Gene ExpressionPreprint
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Can the HEARTS initiative reduce the burden of cardiovascular disease?
O'Flaherty, M., Sudharsanan, N., & Kypridemos, C. (2024) · BMJ evidence-based medicine · doi:10.1136/bmjebm-2023-112590
“15 16 However, implementing effective policies continues to be a challenge.”
Background
Effect of salt substitute and medication use among high cardiovascular risk patientsPreprint
Qi, Z., Tang, S., Hao, Y., Li, Y., Hao, T., Yang, H., Shen, Y., Huang, L., Tian, M., Feng, X., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-4333779/v1
FACTORS ASSOCIATED WITH THE QUALITY OF LIFE OF HYPERTENSION PATIENTS
Gultom, A. B., & Batubara, A. (2024) · Journal of Law and Sustainable Development · doi:10.55908/sdgs.v12i6.3710 · Cited by 2
“Salt reduction programs provide evidence linking salt to health, a particular focus on blood pressure and cardiovascular disease, as well as their potential mechanisms (He et al., 2020).”
Background
Exposing Faults in the Foundation: Sodium-restrictive Guidance for Ambulatory Heart Failure
Krukowski, D. C., & Rao, V. N. (2024) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2024.07.010
Association Between Dietary Components and Autoimmune Diseases
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Kochsalz in der Ernährung
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ATIŞTIRMALIK BESİNLERİN TUZ İÇERİKLERİ: KLİNİK KARAR VERİCİLERİN KULLANIMINA YÖNELİK VERİ TABANI OLUŞTURULMASI
Kunduracı, Y. E., Şahan, R., & Çelik, M. N. (2024) · Anadolu Üniversitesi mesleki eğitim ve uygulama dergisi. · doi:10.70756/anameud.1546788
Usage of table salt and risk of all-cause and cardiovascular disease mortality among patients with diabetes: a national population-based cohort study
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Causal relationship of salt intake with osteoarthritis: A Mendelian randomization analysis
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“[48] Finally, the study methodology itself may have influenced the findings.”
Documento de recomendaciones de la Sociedad Española de Arteriosclerosis (SEA). La dieta en la prevención cardiovascular. Actualización 2024
Ros, E., Pérez‐Martínez, P., Estruch, R., López‐Miranda, J., Ferrer, C. S. I., Delgado‐Lista, J., Gómez-Delgado, F., Solà, R., & Pascual, V. (2024) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2024.10.001 · Cited by 2
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Prescrizione dietetica nell’ipertensione arteriosa
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Sex modifies association between dietary sodium intake and cardiovascular disease mortality among US adult with hypertension: a national population-based cohort
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“…for individuals with hypertension who are treated with diuretics to manage blood pressure and exhibit a high prevalence of renal dysfunction, the use of a single overnight urine sample to estimate 24-h urinary sodium excretion as a proxy for daily sodium intake presents a notable limitation (24).”
SYSTEMATIC LITERATURE REVIEW HUBUNGAN KONSUMSI NATRIUM DENGAN KEJADIAN HIPERTENSI PADA REMAJA
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PTPRE Aggravates Vascular Smooth Muscle Cells Phenotypic Transformation and Vasomotor Dysfunction In Salt-Sensitive HypertensionPreprint
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Seasoning Practices Influence Sodium‒Food Interactions and Shape Perceived Saltiness: Insights from a Sodium Nmr and Sensory StudyPreprint
Monod, R., Bonny, J.-M., Houinsou-Houssou, B., Septier, C., This, H., Salles, C., Clerjon, S., & Thomas‐Danguin, T. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5080920
Lifestyle Differences Between Rural and Urban Communities In Hypertension Prevention
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Рекомендації Європейського товариства кардіологів ESC 2024 з лікування підвищеного артеріального тиску та гіпертензії
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Nutritional energy production
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Self-citation
Lipidomics reveals the possible inhibition mechanism of light salting on the lipid degradation in grass carp ( Ctenopharyngodon idella ) muscle during extended cold storage
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“Analysen aus mehreren Langzeitstudien zeigen, dass eine Reduktion der Salzaufnahme um 2,5g pro Tag mit einer Risikoreduktion für kardiovaskuläre Ereignisse um 20% assoziiert ist, was vor allem auf blutdrucksenken-de Effekte zurückzuführen ist [16].”
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Self-citation

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.
ORCID: He, Feng J.
Tan, Monique
Ma, Yuan
MacGregor, Graham A.
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)
DOI: 10.1016/j.jacc.2019.11.055
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 383 d)
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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Salt Reduction to Prevent Hypertension and Cardiovascular Disease

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