The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis

Jafarnejad, Sadegh; Mirzaei, Hamed; Clark, Cain C. T.; Taghizadeh, Mohsen; Ebrahimzadeh, Armin

doi:10.1186/s12872-020-01347-x

Cited by 13 publications

(12 citation statements)

References 55 publications

(85 reference statements)

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“…4,5,13,14 Although a systematic review and meta-analysis of other studies showed larger effects of salt substitution on blood pressure, all of these studies were of shorter duration than the current trial. 15 Incomplete adherence to use of the salt substitute, consumption of regular salt outside the home, and some use of a salt substitute in the control group probably attenu-ated the magnitude of the treatment effects in the current trial.…”

Section: Discussionmentioning

confidence: 90%

Effect of Salt Substitution on Cardiovascular Events and Death

Neal¹,

et al. 2021

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BACKGROUNDSalt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODSWe conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTSA total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76). CONCLUSIONSAmong persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt.

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Section: Discussionmentioning

confidence: 90%

Effect of Salt Substitution on Cardiovascular Events and Death

Neal¹,

et al. 2021

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“…Moreover, in a salt-substitution trial conducted in Taiwan, the risk of CVD mortality was 41% less in those assigned to the potassium-enriched salt substitute group at 31 months (age-adjusted hazard ratio, 0.59 [95% CI, 0.37–0.95]) [ 104 ]. In previous meta-analyses, a significant positive effect of salt substitutes on SBP and DBP was reported [ 105 , 106 ]; however, in the present study, we included a larger number of related studies so as to conduct a stratified analysis on different factors, including age, baseline HTN status, follow-up duration, and sample size, which can influence the effect of the salt substitute on BP.…”

Section: Discussionmentioning

confidence: 99%

Effect of salt reduction interventions in lowering blood pressure: A comprehensive systematic review and meta-analysis of controlled clinical trials

et al. 2022

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Background Excessive salt intake results in hypertension (HTN), which is a major risk factor for cardiovascular disease (CVD). This review and meta-analysis aimed to evaluate the effect of salt reduction interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods Studies were identified via systematic searches of the databases, including PubMed, Embase, Scopus, and Web of Science. All the studies examining the effectiveness of salt reduction interventions on blood pressure (BP), regardless of age, sex, and HTN status, were included in the systematic review, and eligible studies were used in the meta-analysis. A random-effect model was applied for quantitative data synthesis. Results A total of 50 trials extracted from 40 articles (21 trials on nutrition education,10 on self-help materials,17 on salt substitutes, and 2 on food reformulation) were included in the systematic review. The pooled results of 44 eligible trials showed that salt substitution and nutrition education interventions had significant effects on both SBP (WMD: -7.44 mmHg, P<0.001 and WMD: -2.75 mmHg, P<0.001, respectively), and DBP (WMD: -3.77 mmHg, P<0.001 and WMD: -2.11 mmHg, P<0.001, respectively). Furthermore, using self-help materials led to a significant reduction in SBP among subjects aged 25–60 years (WMD: -2.60 mmHg, P = 0.008); it also decreased both SBP and DBP among those who were hypertensive (WMD: -3.87 mmHg, P = 0.003 and WMD: -2.91 mmHg, P<0.001, respectively). Conclusion Our results supported that salt substitution and nutrition education are effective nutrition strategies to lower BP. It seems that multi-component approaches could be more effective in improving BP status. However, further trials are required.

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“…[3][4][5][6]10,12,40 O consumo adequado de frutas e vegetais potencializa o efeito benéfico da dieta com baixo teor de sódio sobre a PA. Os substitutos do sal contendo cloreto de potássio e menos cloreto de sódio (30% a 50%) são úteis para reduzir a ingestão de sódio e aumentar a de potássio, apesar de limitações em seu uso. 42…”

Section: Sódio (Gr: I; Ne: A)unclassified