Blood Pressure Effects of Sodium Reduction

Filippini, Tommaso; Malavolti, Marcella; Whelton, Paul K.; Naska, Androniki; Orsini, Nicola; Vinceti, Marco

doi:10.1161/circulationaha.120.050371

Cited by 167 publications

(36 citation statements)

References 133 publications

(56 reference statements)

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“…Thus, the indifferent BPlowering effect following salt restriction in normotensive individuals is potentially related to differential activation of neuro-hormonal factors compared to patients with hypertension [58]. However, in additional meta-analyses, the exclusion of short-duration trials was associated with a significant BP-lowering effect independently of hypertension status [53][54][55][56][57]60].…”

Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

“…The most recent update of meta-analytical approaches is presented in Table 1 (Ref. [52][53][54][55][56][57][58][59][60]).…”

Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

“…Almost all meta-analyses provided evidence about the significant lowering effect of sodium reduction on BP, ranging from -2.5 (95% CI: -3.8 to -1.2) to -4.8 (95% CI: -3.9 to -5.7) mmHg, regarding SBP and from -1.2 (95% CI: -1.8 to -0.7) to -2.1 (95% CI: -2.7 to -1.5) mmHg, regarding diastolic blood pressure (DBP) [52][53][54][55][56][57]59,60], for a median sodium reduction ranging from -1.13 (range: -1.50 to -0.74) to -2.30 (range: -7.54 to -0.46) g per day [52][53][54][55]57,60]. All meta-analyses agreed that for the same reduction in salt intake BP reduction was greater in patients with hypertension compared to individuals without hypertension.…”

Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

See 2 more Smart Citations

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Filippou¹,

Tatakis²,

Polyzos³

et al. 2022

Rev. Cardiovasc. Med.

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Despite considerable advances in pharmacological treatments, hypertension remains a major cause of premature morbidity and mortality worldwide since elevated blood pressure (BP) adversely influences cardiovascular and renal outcomes. Accordingly, the current hypertension guidelines recommend the adoption of dietary modifications in all subjects with suboptimal BP levels. These modifications include salt intake reduction and a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet (MedDiet), independently of the underlying antihypertensive drug treatment. However, dietary modifications for BP reduction in adults with prehypertension or hypertension are usually examined as stand-alone interventions and, to a lesser extent, in combination with other dietary changes. The purpose of the present review was to summarize the evidence regarding the BP effect of salt restriction in the context of the DASH diet and the MedDiet. We also summarize the literature regarding the effects of these dietary modifications when they are applied as the only intervention for BP reduction in adults with and without hypertension and the potent physiological mechanisms underlying their beneficial effects on BP levels. Available data of randomized controlled trials (RCTs) provided evidence about the significant BP-lowering effect of each one of these dietary strategies, especially among subjects with hypertension since they modulate various physiological mechanisms controlling BP. Salt reduction by 2.3 g per day in the DASH diet produces less than half of the effect on systolic blood pressure (SBP)/diastolic blood pressure (DBP) (-3.0/-1.6 mmHg) as it does without the DASH diet (-6.7/-3.5 mmHg). Although their combined effect is not fully additive, low sodium intake and the DASH diet produce higher SBP/DBP reduction (-8.9/-4.5 mmHg) than each of these dietary regimens alone. It is yet unsettled whether this finding is also true for salt reduction in the MedDiet.

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Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

“…The most recent update of meta-analytical approaches is presented in Table 1 (Ref. [52][53][54][55][56][57][58][59][60]).…”

Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

Section: To What Extent Should Sodium Intake Be Lowered?mentioning

confidence: 99%

See 1 more Smart Citation

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Filippou¹,

Tatakis²,

Polyzos³

et al. 2022

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…This could be mainly due to the fact that dietary sodium restriction has a significant BP-lowering effect. A very recent and huge meta-analysis of 85 trials, mainly carried out on hypertensive patients, with sodium intake ranging from 0.4 to 7.6 g/day and follow-up from 4 weeks to 36 months, showed an approximately linear relationship between sodium intake and increase in both systolic and diastolic BP across the entire range of dietary sodium exposure [5]. Another meta-analysis of 17 cohorts with 457 participants showed that salt restriction was associated with a significant reduction in augmentation index (9.3%) as well as central systolic BP and central pulse pressure [6].…”

Section: Introductionmentioning

confidence: 99%

Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction

Cicero

Veronesi

Fogacci

2021

High Blood Press Cardiovasc Prev

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Lifestyle improvement is a cornerstone of cardiovascular disease prevention and has a relevant effect on blood pressure control. During the last decades the attention of the researcher has focused on low-salt diets as the lifestyle modification most effective in blood pressure reduction. Current international guidelines thus suggest to stress the importance of the implementation of the dietary approach to stop hypertension (DASH) diet and of a low-salt Mediterranean diet to achieve the best results in term of blood pressure decrease. However, salt reduction in diet could be not the only nor the main determinant of blood pressure reduction under dietary treatment. DASH and low-salt Mediterranean diet are also characterized by a high intake of vegetables (NO and polyphenol sources), whole grains, some low-fat dairy products, and low intake of red meat, sugar, and trans-hydrogenated fats. Lacto-ovo vegetarian diet are also per se associated to a significant improvement in blood pressure levels. Moreover, these diets are particularly effective when associated with a significant weight loss. Furthermore, blood pressure can also be lowered by some nutraceuticals (beetroot, magnesium, vitamin C, catechin-rich beverages, lycopene, etc). The aim of this narrative review is to critically resume the most recent evidence supporting a complete approach to dietary counseling for hypertension prevention and management.

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“…In humans, an increase in potassium intake has been linked to decreasing blood pressure levels and stroke incidence, with an indication of a possible U-shape relationship with minimum risk at 3.5 g/day (i.e., 90 mmol/day) of potassium excretion [ 10 , 11 ]. Conversely, a decrease in sodium intake showed an approximately linear association with blood pressure levels [ 12 ], cardiovascular diseases [ 13 ], and stroke [ 14 ], with beneficial effects of sodium reduction in both subjects with and without hypertension [ 12 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Sodium and Potassium Content of Foods Consumed in an Italian Population and the Impact of Adherence to a Mediterranean Diet on Their Intake

et al. 2021

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High sodium and low potassium intakes are associated with increased levels of blood pressure and risk of cardiovascular diseases. Assessment of habitual dietary habits are helpful to evaluate their intake and adherence to healthy dietary recommendations. In this study, we determined sodium and potassium food-specific content and intake in a Northern Italy community, focusing on the role and contribution of adherence to Mediterranean diet patterns. We collected a total of 908 food samples and measured sodium and potassium content using inductively coupled plasma mass spectrometry. Using a validated semi-quantitative food frequency questionnaire, we assessed habitual dietary intake of 719 adult individuals of the Emilia-Romagna region. We then estimated sodium and potassium daily intake for each food based on their relative contribution to the overall diet, and their link to Mediterranean diet patterns. The estimated mean sodium intake was 2.15 g/day, while potassium mean intake was 3.37 g/day. The foods contributing most to sodium intake were cereals (33.2%), meat products (24.5%, especially processed meat), and dairy products (13.6%), and for potassium they were meat (17.1%, especially red and white meat), fresh fruits (15.7%), and vegetables (15.1%). Adherence to a Mediterranean diet had little influence on sodium intake, whereas potassium intake was greatly increased in subjects with higher scores, resulting in a lower sodium/potassium ratio. Although we may have underestimated dietary sodium intake by not including discretionary salt use and there may be some degree of exposure misclassification as a result of changes in food sodium content and dietary habits over time, our study provides an overview of the contribution of a wide range of foods to the sodium and potassium intake in a Northern Italy community and of the impact of a Mediterranean diet on intake. The mean sodium intake was above the dietary recommendations for adults of 1.5–2 g/day, whilst potassium intake was only slightly lower than the recommended 3.5 g/day. Our findings suggest that higher adherence to Mediterranean diet patterns has limited effect on restricting sodium intake, but may facilitate a higher potassium intake, thereby aiding the achievement of healthy dietary recommendations.

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Blood Pressure Effects of Sodium Reduction

Cited by 167 publications

References 133 publications

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Overview of salt restriction in the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet for blood pressure reduction

Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction

Sodium and Potassium Content of Foods Consumed in an Italian Population and the Impact of Adherence to a Mediterranean Diet on Their Intake

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