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Recommendations Summary

HTN: Dietary Sodium 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    HTN: Sodium Intake

    Dietary sodium intake should be limited to no more than 2300 mg sodium (100 mmol) per day. Reduction of dietary sodium to recommended levels lowers systolic blood pressure by approximately 2 - 8 mmHg.

    Rating: Strong
    Imperative

    HTN: Sodium Intake Monitoring and Evaluation

    If the patient demonstrates adherence to a 2300 mg sodium diet but has not achieved the treatment goal, then the dietitian should recommend the DASH dietary pattern and/or reduction in sodium to 1600 mg to further reduce blood pressure.

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      Consideration should be given to individuals enagaging in high levels of physical activity, or in humid climates, resulting in excessive sweating due to the potential of hyponatremia.

    • Conditions of Application

      For individuals who do not achieve the treatment goal, further dietary modification and collaboration with other members of the health care team may be necessary.

    • Potential Costs Associated with Application

      None.

    • Recommendation Narrative

      For both Sodium Intake and Sodium Intake:  Monitoring and Evaluation recommendations:

      • Based on the JNC 7 report, dietary sodium should be reduced to no more than 100 mmol per day (2.4 g of sodium), resulting in an approximate systolic blood pressure reduction of 2 - 8 mmHg.
      • Based on the JNC 7 report, a 1600 mg sodium DASH dietary pattern has blood pressure effects similar to single drug therapy in some individuals, and combinations of two or more lifestyle modifications can achieve even better results.
      • Eleven studies report a positive association between increased sodium intake and hypertension; five of these studies also report a positive association between the sodium-potassium ratio and blood pressure (Cheung et al, 2000, Hu and Tian, 2001; Liu et al, 2001; Schroder et al, 2002; Geleijnse et al, 2003; He and MacGregor, 2003; Hajjar and Kotchen, 2003; Kwok et al, 2003; Geleijnse et al, 2004; Khaw et al, 2004; Zhao et al, 2004).
      • Three randomized controlled trials and three meta-analyses report reductions in sodium intake ranging from 920 to 2, 300 mg per day (40 - 100 mmol per day) lowers systolic blood pressure by approximately two to six mm Hg and diastolic blood pressure by approximately two to three mm Hg (He et al, 2000; Appel et al, 2001; Espeland et al, 2002; Geleijnse et al, 2003; He and MacGregor, 2003; Geleijnse et al, 2004). 
      • A fourth randomized controlled trial reported maximal blood pressure lowering of 7.1 mm Hg systolic blood pressure in participants without hypertension, and 11.5 mm Hg systolic blood pressure in hypertensive subjects who followed a combination of the DASH dietary pattern and a sodium reduction to 1, 150 mg (Sacks et al, 2001).
      • Two studies reported no significant differences in sodium intake between hypertensive and normotensive subjects, however, this may be more reflective of dietary changes occurring after diagnosis (Silaste et al, 2000; Lancaster et al, 2004).

    • Recommendation Strength Rationale

      • Conclusion Statement is Grade I
      • Updated from The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Arch Intern Med 1997; 157:2413-46.
      • Published in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.  JAMA 2003;289:2560-71.

    • Minority Opinions

      Consensus reached.