Supplemental Vitamin E (100 IU to 1200 IU/day) alone, or in combination with other antioxidants, has not been shown to have a favorable or unfavorable effect serum lipids.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Supplemental Vitamin E, given in both natural and synthetic forms, in doses between 30-600 mg/day or 400-800 IU/day, alone or in combination with other antioxidants, has not been shown to decrease the risk for all cause mortality, cardiovascular death, fatal or nonfatal MI. Doses at this level have not been shown to cause harm.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Five RCTs, which included African American or black (United Kingdom) subjects, assessed the blood pressure response to sodium intake. All six analyses concluded that in the absence of antihypertensive medication, blood pressure was significantly decreased in African American or black subjects when they consumed a lower sodium (10 to 100mmol Na per day) vs. a higher sodium diet.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Limited evidence exists related to this question. One RCT reported that 92 Hispanics who were hypertensive and salt-sensitive experienced increased blood pressure (BP) with higher dietary sodium intake (200mmol to 250mmol per day of sodium) vs. a low sodium intake (50mmol to 80mmol per day of sodium). More research is needed regarding the relationship between sodium intake and BP in Hispanic subjects.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Six epidemiologic studies demonstrate a positive association between higher sodium intake and elevated blood pressure in Asian populations residing in China and India. No evidence meeting our criteria was available on Asian American subjects residing in the United States. More research is needed in this population. 

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

One meta analysis (nine RCTs and one non-randomized control trial, N=966) assessing the effect of sodium or salt on blood pressure (BP), found an increase in sodium or salt intake resulted in an increase in systolic blood pressure (SBP) and diastolic blood pressure. One cross-sectional study determined sodium intake is positively correlated with BP levels and mean arterial pressure. A second cross-sectional study showed a positive correlation with BP levels and pulse pressure. One cohort study found a weak correlation between sodium excretion and SBP.  

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

In four out of five studies of normotensive* adults, a lower sodium or sodium chloride intake resulted in significantly lower blood pressure (BP) (-1.0 to -10.5mm Hg SBP; -0.8 to -5.3mm Hg DBP). Lowered blood pressures were noted with reductions in sodium or sodium chloride intake from 150 to 220mmol to 20 to 120mmol. Factors that affect this relationship included dietary pattern, race, ethnicity and age of subjects. A greater BP-lowering response was observed in the following groups:

• Those with a higher initial level of sodium intake
• Those consuming a low sodium diet with their usual dietary pattern vs. a DASH dietary pattern
• In black subjects
• In older subjects.

* In some studies, NTN may also include PHTN due to changes in the definition of each.  

See Table: Sodium and Blood Pressure Response

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
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• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Depletion and loading methods were used for determining salt sensitivity in the clinical setting. A significant relationship of blood pressure (BP) response to salt/sodium (Na) depletion and load was observed. In adults with varying levels of BP, a dietary or an intravenous (IV) method of Na depletion (10 to 50mmol per day, three days or less) and Na loading (150 to 400mmol per day, three days or more), both with BP monitoring throughout the test period, provide strong evidence that this is an acceptable method. 

• Grade I means there is Good/Strong evidence supporting the statement;
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• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

One positive-quality RCT showed that there is no relationship between sodium bicarbonate (NaHCO₃) intake and blood pressure in normotensive adults. More research in this area is needed.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

There is no evidence to suggest a relationship between sodium citrate intake and blood pressure in normotensive adults. More research is needed in this area.

• Grade I means there is Good/Strong evidence supporting the statement;
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• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

There is no evidence to suggest a relationship between sodium glutamate intake and blood pressure in normotensive adults. More research is needed in this area.

• Grade I means there is Good/Strong evidence supporting the statement;
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• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

The findings from seven studies do not support a strong relationship between increasing magnesium intake and lowered blood pressure in healthy and hypertensive adults.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

Fifteen studies support a modest relationship between increasing intake of potassium and a lower sodium-potassium ratio with lowered blood pressure in healthy and hypertensive adults.

• Grade I means there is Good/Strong evidence supporting the statement;
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• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
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• Ungraded means a grade is not assignable.

Supplemental Vitamin C and E, Beta-carotene, and Selenium should not be taken with Simvastatin-Niacin drug combination because the combination of these antioxidants may lower HDL₂-C, a beneficial subfraction of HDL-C.

• Grade I means there is Good/Strong evidence supporting the statement;
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• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
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• Ungraded means a grade is not assignable.

Twelve studies investigating the effect of vitamin C on blood pressure report inconclusive findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
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• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Six studies investigating the effect of vitamin E on blood pressure report inconclusive findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

The findings from ten studies do not support a strong relationship between increasing calcium intake and lowered blood pressure in healthy and hypertensive adults.

• Grade I means there is Good/Strong evidence supporting the statement;
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• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

Supplemental Vitamin C (50-1,000 mg/day) in combination with other antioxidants (vitamin E, B-carotene, selenium) has not been shown to have any effect on all cause mortality, cardiovascular death, fatal or nonfatal MI.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
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• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Seventeen studies demonstrate the benefit of reducing dietary sodium intake for lowering blood pressure. A sodium intake of less than 2,300mg per day and further reduction of sodium intake to 1,600mg may have additional blood pressure-lowering effects, especially when combined with the DASH dietary pattern.

• Grade I means there is Good/Strong evidence supporting the statement;
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• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
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• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

Supplemental folate (0.5-2.5 mg) given alone or in combination with B6 (10-25 mg) and B12 (0.4 mg) reduce homocysteine levels by 17-34% but did not reduced the risk for coronary events after 6 months to 2 years in stable CAD patients, post-stroke patients or post-angioplasty patients that had normal baseline homocysteine and total cholesterol concentrations.

• Grade I means there is Good/Strong evidence supporting the statement;
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• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
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• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.

Supplemental Vitamin C (50-1,000 mg/day) in combination with other antioxidants (vitamin E, b-carotene, selenium) has not been shown to have any effect on all cause mortality, cardiovascular death, fatal or nonfatal MI.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
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• Low (C) means our confidence in the effect estimate is limited;
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• Ungraded means a grade is not assignable.