Cited by 855Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

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Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations

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Elliott, Paul, Stamler, Jeremiah, Nichols, Rob, Dyer, Alan R, Stamler, Rose, Kesteloot, Hugo, Marmot, Michael·1996·BMJ

DOI 10.1136/bmj.312.7041.1249PMC PMC2351086

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Abstract

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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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
ORCID: Elliott, Paul
Marmot, Michael
Venue: BMJ
Publisher: BMJ
Published: 1996-05-18
Volume: 312
Issue: 7041
Pages: 1249-1253
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.312.7041.1249
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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Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations

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