Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations
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Objectives : To assess further the relation in Intersalt of 24 hour urinary sodium to blood pressure of individuals and populations, and the difference in blood pressure from young adulthood into middle age. Design : Standardised cross sectional study within and across populations. Setting : 52 population samples in 32 countries. Subjects : 10 074 men and women aged 20-59. Main outcome measures : Association of sodium and blood pressure from within population and cross population multiple linear regression analyses with multivariate correction for regression dilution bias. Relation of sample median daily urinary sodium excretion to difference in blood pressure with age. Results : In within population analyses (n=10 074), individual 24 hour urinary sodium excretion higher by 100 mmol (for example, 170 v 70 mmol) was associated with systolic/diastolic blood pressure higher on average by 3/0 to 6/3 mm Hg (with and without body mass in analyses). Associations were larger at ages 40-59. In cross population analyses (n=52), sample median 24 hour sodium excretion higher by 100 mmol was associated with median systolic/diastolic pressure higher on average by 5-7/2-4 mm Hg, and estimated mean difference in systolic/diastolic pressure at age 55 compared with age 25 greater by 10-11/6 mm Hg. Conclusions : The strong, positive association of urinary sodium with systolic pressure of individuals concurs with Intersalt cross population findings and results of other studies. Higher urinary sodium is also associated with substantially greater differences in blood pressure in middle age compared with young adulthood. These results support recommendations for reduction of high salt intake in populations for prevention and control of adverse blood pressure levels. Key messages: The within population findings were previously underestimated because of incomplete correction for the regression dilution problem Revised estimates of the within population association of sodium to blood pressure in Intersalt are concordant with the cross population findings for 52 samples Estimates of the effect of median sodium excretion higher by 100 mmol/day over a 30 year period (age 55 minus age 25) were a greater difference of 10-11 mm Hg in systolic blood pressure and 6 mm Hg in diastolic blood pressure These results lend further support to recommendations for mass reduction of high salt intake for the prevention and control of adverse blood pressure levels and high blood pressure in populations
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Evidence from individual-level trials of salt and blood pressure and from cross-population studies indicates that the high blood pressure burden in high-income Asia Pacific and central Europe is likely driven partly by high salt consumption.
“evidence from individual-level trials of salt and blood pressure and from cross-population studies indicates that this result is likely to be driven partly by high salt consumption in these regions.94,158”
The theoretical-minimum-risk exposure distribution was selected based on values reported in randomised trials; studies of populations with low cardiovascular disease prevalence suggest benefits likely continue to lower levels.
“The theoretical-minimum-risk exposure distribution was selected on the basis of values reported in randomised trials; studies of populations with low prevalence of cardiovascular disease suggest that benefits are likely to continue to lower levels.158”
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- Authors
- Elliott, P., Stamler, J., Nichols, R., Dyer, A. R., Stamler, R., Kesteloot, H., & Marmot, M.
- Affiliations
- Imperial College London (GB)
- General Department of Preventive Medicine (VN)
- Northwestern University (US)
- KU Leuven (BE)
- University College London (GB)
- Corresponding author
- Elliott, Paul
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1996-05-18
- Volume
- 312
- Issue
- 7041
- Pages
- 1249-1253
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2351086
- OpenAlex
- W1639251217
- Cited by
- 855
- References
- 36
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 18 · 2023: 23 · 2022: 24 · 2021: 27 · 2020: 35 · 2019: 36 · 2018: 18 · 2017: 35 · 2016: 42 · 2015: 43 · 2014: 37 · 2013: 42 · 2012: 38
- FWCI
- 31.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust
- National Research Foundation
- National Heart, Lung, and Blood Institute
- 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, 24-hour urine sodium, blood pressure, systolic blood pressure, diastolic blood pressure, salt intake, regression dilution bias, INTERSALT, age-related blood pressure changes, middle age (human life stage), salt reduction, hypertension prevention, cross-population comparison, body mass
- MeSH terms
- Adult, Aging, Blood Pressure, Circadian Rhythm, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Population Surveillance, Regression Analysis, Sodium, Sodium, Dietary, Body Mass Index, Multivariate Analysis, Nutrition Policy
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