A randomized trial on sodium reduction in two developing countries

Abstract

Hypertension remains the most common cardiovascular risk factor in developing countries, yet the majority of patients have no access to pharmacological therapy. Population-wide preventive strategies, such as salt restriction, are an attractive alternative, but experience in resource-poor settings is limited. To address this question, we conducted a randomized crossover study of salt restriction in adults living in Nigeria and Jamaica in order to estimate the mean blood pressure (BP) response. After a 4-week run-in period to determine willingness to adhere to a low-salt diet, 56 Jamaicans and 58 Nigerians completed an 8-week crossover study of low-salt and high-salt intake. Baseline BPs were in the normotensive range (systolic ¼ 125 mmHg in Jamaica, 114 mmHg in Nigeria). Baseline urinary sodium excretion was 86.8 and 125.6 mEq/day in Nigeria and Jamaica, respectively. The mean difference between urinary sodium excretion at baseline and at the end of the 3-week low-sodium phase was 33.6 mEq/day in Nigeria and 57.5 mEq/day in Jamaica. During the high-sodium phase, mean change in urinary sodium excretion from baseline to week 3 was 35.0 and 5.5 mEq/day in Nigeria and Jamaica, respectively. The mean change in systolic BP ('high' vs 'low' sodium phase) was approximately 5 mmHg in both groups. This study suggests that the efficacy of sodium reduction in developing countries equals those noted in more affluent cultures. If promoted on a wide scale, sodium reduction could be used to treat persons with established hypertension, and more importantly, to prevent age-related increases in BP in poor communities.

Prevalence and Associated Factors of Hypertension among Adults in Durame Town, Southern Ethiopia

“…This is due to the fact that family members may share similar life style and genetic factors. It has been demonstrated that people who reported ever use of top added salt on plate had a positive association with hypertension which was evidenced elsewhere [20],[21]. It is already an established fact that a high salt diet disrupts the natural sodium balance in cells.…”

Incidence of hypertension by alcohol consumption: is it modified by race?

“…Individuals of African ancestry in the USA are at higher risk of developing hypertension [22][23][24][25] than those of European origin and there is evidence that they are more susceptible to sodium overload [26,27]. The possibility that a similar susceptibility occurs in the case of alcohol consumption should be confirmed in experimental models.…”

Patterns of sodium and potassium excretion and blood pressure in the African Diaspora

“…1–4, 26–29 Our previous comparative trial in Nigeria and Jamaica demonstrated quantitatively similar responses to sodium reduction in normotensive individuals. 30 …”