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



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.

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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 information




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.

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Correspondence to Farshad Farzadfar.

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Gholami, A., Rezaei, S., Jahromi, L.M. et al. Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016. Eur J Nutr 59, 3149–3161 (2020).

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  • Salt
  • Blood pressure
  • Hypertensive
  • Normotensive
  • Iran