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Recommendations Summary

HTN: Sodium 2015

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

    The registered dietitian nutritionist (RDN) should counsel on reducing sodium intake for blood pressure (BP) reduction in adults with hypertension (HTN).  Research indicates that lowering dietary sodium intake to 1, 500mg to 2, 000mg per day reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) up to 12mm Hg and 6mm Hg, respectively.  

    Rating: Strong

    • Risks/Harms of Implementing This Recommendation

      Clinical judgment should be applied for those with certain medical conditions (e.g., heart failure) or who are taking medications (e.g., thiazide diuretics) that can cause hyponatremia.

    • Conditions of Application

      There are no conditions that may limit the application of this recommendation.

    • Potential Costs Associated with Application

      There are no costs associated with the application of this recommendation.

    • Recommendation Narrative

      A total of 13 studies were included in the evidence analysis supporting the recommendation: 

      • Three positive quality meta-analyses (Graudal et al, 2015; Graudal et al, 2012; He et al, 2013)
      • Three positive quality cross-sectional studies (Kwok et al, 2003; Mente et al, 2014; Schroder et al, 2002)
      • Two positive quality randomized crossover trial (He et al, 2009; Jablonski et al, 2013)
      • One positive quality non-randomized controlled trial (Kojuri and Rahimi, 2007)
      • One positive quality case-control study (Cheung et al, 2000)
      • Three neutral quality cross-sectional studies (Hu and Tian, 2001; Khaw et al, 2004; Lancaster et al, 2004).
      Thirteen studies (including three meta-analyses) provide evidence that there is a significant positive relationship between sodium intake and BP in adults with HTN. In four studies, BP increased with higher levels of sodium intake. In five studies, including two meta-analyses, a decrease in dietary sodium intake to 1, 500mg to 2, 000mg per day reduced SBP and DBP, up to 12mm Hg and 6mm Hg, respectively. 
      • Associations between sodium intake, BP and HTN risk in hypertensive individuals: Positive relationships between sodium intake, BP and hypertension risk were observed in five of six studies (Cheung et al, 2002; Hu and Tian, 2001; Khaw et al, 2004; Mente et al, 2014; Schroder et al, 2002). In one study (Lancaster et al, 2004), dietary intake of sodium by normotensives was significantly higher than diagnosed hypertensives. 
      • Effect of reduced sodium intake on BP in hypertensive individuals: Significant decreases in BP were observed with reduced sodium intake in three studies (He et al, 2009; Kojuri and Rahimi, 2007; Jablonski et al, 2013) and three meta-analyses of RCTs conducted since 1948 (He et al, 2013; Graudal et al, 2011, Graudal et al, 2015)
      • Sodium dose and BP response: A meta-analysis of four studies (Graudel et al, 2015) showed that compared with a low sodium intake (less than 90mmol, 2, 070mg), there was a significant increase in BP with increasing levels of intake in hypertensive individuals.

    • Recommendation Strength Rationale

      Conclusion statement is Grade I.

    • Minority Opinions