Dietary salt restriction is recommended for the prevention of cardiovascular disease in patients with hypertension and heart failure as well as in the general population. However, salt reduction is very difficult without knowing the daily salt intake of individual patients. A total of 524 subjects (72 ± 10 year old, 246 female) who visited an outpatient cardiology clinic were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations of spot urine at the time of enrollment and during follow-up for 8-26 weeks. The attending physicians explained the individual data to the patients and encouraged them to reduce their salt intake through simple counseling. The baseline estimated salt excretion was 9.6 ± 2.7 (range: 3.5-22.1) g per day, which decreased to 8.7 ± 2.3 (3.7-18.0) g per day during follow-up. The systolic blood pressure decreased from 127.0±15.4 (range: 80-170) to 125.6±14.5 (80-172) mm Hg (P ¼ 0.026), and the diastolic blood pressure decreased from 73.4 ± 11.0 (range: 40-106) to 71.5 ± 10.8 (50-102) mm Hg (Po0.001). In conclusion, the estimation of salt intake by spot urine was a useful method for motivating patients to reduce their salt intake; however, achieving salt reduction to the level recommended by the guideline could be a challenge.
The purpose of this study was to evaluate long-term compliance with salt restriction in Japanese cardiology outpatients assessed by spot urine measurements. A total of 466 patients (72 ± 10 years old, 216 females) who visited a cardiology outpatient clinic and were followed for at least 1 year were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations determined by spot urine at the time of enrollment, during an 8-26 week follow-up and at a long-term follow-up (>1 year). The average follow-up duration was 2.2 ± 0.6 (1.0-3.4) years after enrollment, and spot urines were collected 5.2 ± 2.8 times after 1 year. The baseline estimated salt excretion was 9.6 ± 2.7 g per day, which was reduced to 8.7 ± 2.3 g per day (P<0.01) at 8-26 weeks and remained unchanged at the long-term follow-up (8.9 ± 2.0 g per day, P = 0.36 vs. 8-26 weeks, P < 0.01 vs. baseline). The percent of patients who achieved an average salt excretion<6.0 g per day was unchanged from baseline (6.9% vs. 7.7%, P = 0.61). Among several variables (gender, age, body weight, salt excretion at enrollment) that might affect the incidence of salt excretion <6.0 g per day, salt excretion at baseline was the only determinant of successful salt restriction (P<0.01). In conclusion, compliance with salt restriction, assessed using a spot urine method, was maintained over the long term; however, achieving salt reduction to the level recommended by the guidelines remains a challenge.
Changes in BNP levels were associated with changes in the estimated daily salt excretion in outpatients with compensated heart failure. Salt restriction may be beneficial for the management of patients with heart failure.
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