Skip to main content
SpringerLink
Log in

Should Dietary Salt Restriction Be a Basic Component of Antihypertensive Therapy?

  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

The general intake of salt (sodium chloride) is much higher than the recommended allowances, in part because of added salt in food industry processed food. However, population studies have not been able to show an association between salt intake and unfavorable health outcome.

Based on population studies and randomized studies, the effect of an extreme salt reduction of 100 mmol on blood pressure in hypertensive persons is about one third of the effect of antihypertensive medications. This effect-size estimate is based on single measurements of blood pressure and is probably overestimated compared with 24-hour blood pressure measurements. Salt reduction has effects on heart rate and serum levels of renin, aldosterone, catecholamines, and lipids that may be unfavorable. Because of insufficient compliance, extreme salt reduction can only be obtained if salt in food industry processed food is eliminated. The full consequences of such elimination are not known. Other nonpharmacological interventions, such as weight reduction and diets including fruits, vegetables, and low-fat dairy foods, are probably easier to implement and more effective to decrease blood pressure than salt reduction. Furthermore, salt reduction does not seem to add to the effect size when combined with other nonpharmacological interventions. Salt sensitivity due to sodium channel mutations has been shown in a minority of blacks but not in Caucasians.

In conclusion, at present, dietary salt restriction should not be a basic component of antihypertensive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kotchen TA, McCarron DA. Dietary electrolytes and blood pressure. Circulation 1998;98:613-617.

    Google Scholar 

  2. Taubes G. The (political) science of salt. Science 1998;281: 898-907.

    Google Scholar 

  3. Hanneman RL. Intersalt: Hypertension rise with age revisited. Br Med J 1996;312:1283-1287.

    Google Scholar 

  4. Godlee F. The food industry fights for salt. Br Med J 1996; 312:1239-1240.

    Google Scholar 

  5. Chapman CP, Gibbons TB. The diet and hypertension, a review. Medicine 1949;9:29-69.

    Google Scholar 

  6. Watt GCM. Does salt sensitivity exist? Klin Wochenschr 1991;69(Suppl XXV):30-35.

    Google Scholar 

  7. Robertson JIS. How strong is the evidence that recommendations to reduce population average salt intake will reduce mortality from cardiovascular disease. BNF Nutr Bull 1997; 22:181-186.

    Google Scholar 

  8. Swales JD. Studies of salt intake in hypertension. What can epidemiology teach us. Am J Hypertens 1990;3:645-649.

    Google Scholar 

  9. Intersalt cooperative research group. Intersalt: An international study of electrolyte excretion and blood pressure, results for 24-hour urinary sodium and potassium excretion. Br Med J 1988;297:319-328.

    Google Scholar 

  10. Gleibermann L. Blood pressure and dietary salt in human populations. Ecol Food Nutr 1973;2:143-156.

    Google Scholar 

  11. Graudal NA, Gallø e A, Storm T. The effect of salt restriction on the blood pressure. A review with meta-analysis of epidemiological and clinically controlled investigations. Ugeskr Laeger 1991;153:1914-1920.

    Google Scholar 

  12. Smith WCS, Crombie IK, Tavendale RT, Gulland SK, Tunstall-Pedoe HD. Urinary electrolyte excretion, alcohol consumption, and blood pressure in the Scottish heart health study. Br Med J 1988;297:329-330.

    Google Scholar 

  13. Frost CD, Law MR, Wald NJ. By how much does dietary salt reduction lower blood pressure? II-Analysis of observational data within populations. Br Med J 1991;302:815-818.

    Google Scholar 

  14. Elliot P, Stamler J, Nichols R, et al. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Br Med J 1996;312:1249-1253.

    Google Scholar 

  15. Jolious SA, Mullee MA. Confounding and Simpson's paradox. Br Med J 1994;309:1480-1481.

    Google Scholar 

  16. Mertens TE. Estimating the effects of misclassification. Lancet 1993;342:418-421.

    Google Scholar 

  17. Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III-Analysis of data from trials of salt reduction. Br Med J 1991;302:819-824.

    Google Scholar 

  18. Grobbee DE, Hofman A. Does sodium restriction lower blood pressure? Br Med J 1986;293:27-29.

    Google Scholar 

  19. Midgley JP, Matthew AG, Greenwood CMT, Logan AG. Effect of reduced dietary sodium on blood pressure. A metaanalysis of randomized controlled trials. JAMA 1996;275: 1590-1597.

    Google Scholar 

  20. Cutler JA, Follmann D, Allender PS. Randomized trials of sodium reduction: an overview. Am J Clin Nutr 1997;65 (Suppl):643S-651S.

    Google Scholar 

  21. Graudal NA, Gallø e AG, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride,Ameta-analysis. JAMA 1998; 279:1383-1391.

    Google Scholar 

  22. Chrysant SG, Weir MR, Weder AB, et al. There are no racial, age, sex, or weight differences in the effect of salt on blood pressure in salt sensitive hypertensive patients. Arch Intern Med 1997;157:2489-2494.

    Google Scholar 

  23. Zoccali C, Mallamaci F, Cuzzola F, Leonardis D. Reproducibility of the response to short-term low salt intake in essential hypertension. J Hypertens 1996;14:1456-1459.

    Google Scholar 

  24. Beretta-Picolli C, Davies DL, Boddy K, et al. Relation of arterial pressure with body sodium, body potassium and plasma potassium in essential hypertension. Clin Sci 1982; 63:257-270.

    Google Scholar 

  25. Baker EH, Sagnella GA, Rothwell M, et al. Association of hypertension with T594M mutation in b subunit of epithelial sodium channels in black people resident in London. Lancet 1998;351:1388-1392.

    Google Scholar 

  26. Alderman MH, Lamport B. Moderate sodium restriction. Do the benefits justify the hazards? Am J Hypertens 1990; 3:499-504.

    Google Scholar 

  27. Egan BM, Stepniakowski KT. Adverse effects of short-term, very-low-salt diets in subjects with risk-factor clustering. Am J Clin Nutr 1997;65(Suppl):671S-677S.

    Google Scholar 

  28. Bennet WM. Drug interactions and consequences of sodium restriction. Am J Clin Nutr 1997;65(Suppl):678S-681S.

    Google Scholar 

  29. Folkow B, Ely D. The “salt problem” revisited. Importance of the blood pressure-heart rate relationship. Blood Pressure 1998;7:133-138.

    Google Scholar 

  30. MacGregor GA. Salt-more adverse effects. Am J Hypertens 1997;10:37S-41S.

    Google Scholar 

  31. Joossens JV, Hill MJ, Elliot P. Dietary salt, nitrate and stomach cancer mortality in 24 countries. Int J Epidemiol 1996; 25:494-504.

    Google Scholar 

  32. Messerli FH, Schmieder RE, Weir ME. A perpetuator of hypertensive target organ disease. Arch Intern Med 1997; 157:2449-2452.

    Google Scholar 

  33. Carey OJ, Locke C, Cooksen JB. Effect of alterations of dietary sodium on the severity of asthma in men. Thorax 1993; 48:714-718.

    Google Scholar 

  34. Alderman MH, Madhavan S, Ooi WL, Cohen H, Sealey JE, Laragh JH. Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 1991;324:1098-1104.

    Google Scholar 

  35. Alderman MH, Cohen H, Madhavan S. Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey. Lancet 1998;351:781-785.

    Google Scholar 

  36. Tunstall-Pedoe H, Woodward M, Tavendale R, A'Brook R, McCluskey MK. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study. Br Med J 1997;315:722-729.

    Google Scholar 

  37. The trials of hypertension prevention collaborative research group. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood-pressure. Arch Intern Med 1997;157:657-667.

    Google Scholar 

  38. The trials of hypertension prevention collaborative group. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. JAMA 1992;267: 1213-1220.

    Google Scholar 

  39. Hypertension Prevention Trial Research Group. The hypertension prevention trial: three-year effects of dietary changes on blood pressure. Arch Intern Med 1990;150:153-162.

    Google Scholar 

  40. Pickering TG. Lessons from the trials of hypertension prevention, phase II. Arch Intern Med 1997;157:596-597.

    Google Scholar 

  41. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997;336:1117-1124.

    Google Scholar 

  42. Moore TJ, Malarick C, Olmedo A, Klein RC. Salt restriction lowers resting blood pressure but not 24-h ambulatory blood pressure. Am J Hypertens 1991;4:410-415.

    Google Scholar 

  43. Staessen JA, Lijnen P, Thijs L, Fagard R. Salt and blood pressure in community-based intervention trials. Am J Clin Nutr 1997;65(Suppl):661S-670S.

    Google Scholar 

  44. Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons. JAMA 1998;279:839-846.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Tissue Typing Laboratory of the Department of Clinical Immunology, the National University Hospital, University of Copenhagen, Denmark

    Niels Graudal

  2. Department of Cardiology P, Gentofte Hospital, University of Copenhagen, Denmark

    Anders Galløe

Authors
  1. Niels Graudal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anders Galløe
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Graudal, N., Galløe, A. Should Dietary Salt Restriction Be a Basic Component of Antihypertensive Therapy?. Cardiovasc Drugs Ther 14, 381–386 (2000). https://doi.org/10.1023/A:1007808131419

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007808131419

Search

Navigation