Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016

  • Ali Gholami
  • Shahabeddin Rezaei
  • Leila Moosavi Jahromi
  • Hamid Reza Baradaran
  • Ali Ghanbari
  • Shirin Djalalinia
  • Nazila Rezaei
  • Shohreh Naderimagham
  • Mitra Modirian
  • Negar Mahmoudi
  • Zohreh Mahmoudi
  • Mohammad Javad Hajipour
  • Ahmad kousha
  • Siamak Mirab Samiee
  • Farshad FarzadfarEmail author
Original Contribution



There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population.


The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP.


After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p < 0.001) and normotensive people (p < 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p < 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people.


The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people.


Salt Blood pressure Hypertensive Normotensive Iran 



The authors would like to thank Deputy of Research, Technology, and Deputy of Public Health of the Ministry of Health and Medical Education, Islamic Republic of Iran, and National Institute for Health Research for their collaboration in this study. This work was supported by Iran Ministry of Health and Education and National Institute for Health Research [Grant number: 241م93259].

Author contributions

AG, SR, and LMJ had the idea and wrote the primary draft of the manuscript. AG and AG analyzed the data. FF, NR, SD, SN, MM, MJH, AK designed the study. FF, HB revised the manuscript critically. FF, AG, SR contributed in the interpretation of the data. SMS contributed in laboratory measurement designing and interpretation of the laboratory measurement results. NM, ZM contributed in data collection, measurement, and interpretation of the laboratory measurement results.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ali Gholami
    • 1
    • 2
    • 3
  • Shahabeddin Rezaei
    • 4
    • 5
  • Leila Moosavi Jahromi
    • 6
  • Hamid Reza Baradaran
    • 3
    • 7
  • Ali Ghanbari
    • 4
    • 8
  • Shirin Djalalinia
    • 4
    • 9
  • Nazila Rezaei
    • 4
  • Shohreh Naderimagham
    • 4
  • Mitra Modirian
    • 4
  • Negar Mahmoudi
    • 4
  • Zohreh Mahmoudi
    • 4
    • 10
  • Mohammad Javad Hajipour
    • 4
    • 11
  • Ahmad kousha
    • 12
  • Siamak Mirab Samiee
    • 13
  • Farshad Farzadfar
    • 4
    • 10
    Email author
  1. 1.Noncommunicable Diseases Research CenterNeyshabur University of Medical SciencesNeyshaburIran
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthNeyshabur University of Medical SciencesNeyshaburIran
  3. 3.Department of Epidemiology, School of Public HealthIran University of Medical SciencesTehranIran
  4. 4.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
  5. 5.Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran
  6. 6.Health Management and Economics Research CenterIran University of Medical SciencesTehranIran
  7. 7.Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of MedicineMedical Sciences and Nutrition University of AberdeenAberdeenUK
  8. 8.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  9. 9.Deputy of Research and Technology, Ministry of Health and Medical EducationTehranIran
  10. 10.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  11. 11.Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research InstituteBushehr University of Medical SciencesBushehrIran
  12. 12.Department of Health Education and Promotion, Faculty of Health SciencesTabriz University of Medical SciencesTabrizIran
  13. 13.Reference Health LaboratoryMinistry of Health and Medical EducationTehranIran

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