Hypertension

HTN: Minerals (2007)

• Intervention
  What is the relationship between calcium intake and blood pressure in healthy and hypertensive adults?

  • Conclusion

    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: II
    • 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.
  • Evidence Summary: What evidence suggests a relationship between calcium intake and blood pressure in healthy and hypertensive adults?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004; 14 (3): 235-239. 
      • Hajjar I, Kotchen T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: The NHANES III Data. J Nutr. 2003; 133: 211-214.
      • Hajjar IM, Grim CE, Kotchen TA. Dietary calcium lowers the age-related rise in blood pressure in the United States:  the NHANES III Survey. J Clin Hypertens. 2003; 5 (2): 122-126.   
      • Jorde R, Bonaa KH. Calcium from dairy products, vitamin D intake and blood pressure: the Tromso study. Am J Clin Nutr. 2000; 71 (6): 1,530-1,535.
      • Kwok TCY, Chan TYK, Woo J. Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians. European Journal of Clinical Nutrition, 2003; 57: 299-304.
      • Lancaster KJ, Smiciklas-Wright H, Weltzel LB, Mitchell DC, Friedman JM, Jensen GL. Hypertension-related dietary patterns of rural older adults. Preventive Medicine, 2004; 38: 812-818.
      • Morikawa Y, Nakagawa H, Okayama A, Mikawa K, Sakata K, Miura K, Ishizaki M, Yoshita K, Naruse Y, Kagamimori S, Hashimoto T, Ueshima H. A cross-sectional study on association of calcium intake with blood pressure in Japanese population. Journal of Human Hypertension, 2002; 16 (2): 105-110. 
      • Schroder H, Schmelz E, Marrugat J. Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr. 2002; 41 (4): 161-167. 
      • Silaste M-L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesaniemi YA. Dietary and other non-pharmacological treatments in patients with drug-treated hypertension and control subjects. Journal of Internal Medicine. 2000; 247: 318-324.
      • Zhao L, Stamler J, Yan LL, Zhou B, Wu Y, Liu K, Daviglus ML, Dennis BH, Elliott P, Ueshima H, Yang J, Zhu L, Guo D, for the INTERMAP Research Group. Blood pressure differences between northern and southern Chinese: role of dietary factors. The international study on macronutrients and blood pressure. Hypertension, 2004; 43 (6): 1,332-1,337.
  • Search Plan and Results: Calcium 2005
     
  What is the relationship between magnesium intake and blood pressure in healthy and hypertensive adults?

  • Conclusion

    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: II
    • 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.
  • Evidence Summary: What evidence suggests a relationship between magnesium intake and blood pressure in healthy and hypertensive adults?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004; 14 (3): 235-239. 
      • Hajjar I, Kotchen T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: The NHANES III Data. J Nutr. 2003; 133: 211-214.
      • Lancaster KJ, Smiciklas-Wright H, Weltzel LB, Mitchell DC, Friedman JM, Jensen GL. Hypertension-related dietary patterns of rural older adults. Preventive Medicine, 2004; 38: 812-818.
      • Liu L, Liu L, Ding Y, Huang Z, He B, Sun S, Zhao G, Zhang H, Miki T, Mizushima S, Ikeda K, Nara Y, Yamori Y. Ethnic and environmental differences in various markers of dietary intake and blood pressure among Chinese Han and three other minority peoples of China: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. Hypertens Res. 2001; 24 (3): 315-322.
      • Silaste M-L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesaniemi YA. Dietary and other non-pharmacological treatments in patients with drug-treated hypertension and control subjects. Journal of Internal Medicine. 2000; 247: 318-324.
      • Wu G, Tian H, Han K, Xi Y, Yao Y, Ma A. Potassium magnesium supplementation for four weeks improves small distal artery compliance and reduces blood pressure in patients with essential hypertension. Clin Exp Hypertens. 2006; 28 (5): 489-497.
      • Zhao L, Stamler J, Yan LL, Zhou B, Wu Y, Liu K, Daviglus ML, Dennis BH, Elliott P, Ueshima H, Yang J, Zhu L, Guo D, for the INTERMAP Research Group. Blood pressure differences between northern and southern Chinese: role of dietary factors. The international study on macronutrients and blood pressure. Hypertension, 2004; 43 (6): 1,332-1,337.
  • Search Plan and Results: Magnesium 2005
     
  What is the relationship between potassium intake and blood pressure in healthy and hypertensive adults?

  • Conclusion

    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: II
    • 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.
  • Evidence Summary: What evidence suggests a relationship between potassium intake and blood pressure in healthy and hypertensive adults?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cheung BMY, Ho SPC, Cheung AHK, Lau CP. Diastolic blood pressure is related to urinary sodium excretion in hypertensive Chinese patients.  Q J Med. 2000; 93: 163-168.
      • Espeland MA, Kumanyika S, Yunis C, Zheng B, Brown WM, Jackson S, Wilson AC, Bahnson J, Electrolyte intake and nonpharmacologic blood pressure control. Ann Epidemiol. 2002; 12: 587-595. 
      • Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. Journal of Human Hypertension, 2003; 17: 471-480.
      • Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004; 14 (3): 235-239. 
      • Hajjar I, Kotchen T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: The NHANES III Data. J Nutr. 2003; 133: 211-214.
      • Hu G, Tian H. A comparison of dietary and non-dietary factors of hypertension and normal blood pressure in a Chinese population. Journal of Human Hypertension, 2001; 15: 487-493.
      • Khaw KT, Bingham S, Welch A, Luben R, O'Brien E, Wareham N, Day N. Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr. 2004; 80: 1,397-1,403. 
      • Kwok TCY, Chan TYK, Woo J. Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians. European Journal of Clinical Nutrition, 2003; 57: 299-304.
      • Lancaster KJ, Smiciklas-Wright H, Weltzel LB, Mitchell DC, Friedman JM, Jensen GL. Hypertension-related dietary patterns of rural older adults. Preventive Medicine, 2004; 38: 812-818.
      • Liu L, Liu L, Ding Y, Huang Z, He B, Sun S, Zhao G, Zhang H, Miki T, Mizushima S, Ikeda K, Nara Y, Yamori Y. Ethnic and environmental differences in various markers of dietary intake and blood pressure among Chinese Han and three other minority peoples of China: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. Hypertens Res. 2001; 24 (3): 315-322.
      • Naismith DJ, Braschi A. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Br J Nutr. 2003; 90 (1): 53-60.
      • Schroder H, Schmelz E, Marrugat J. Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr. 2002; 41 (4): 161-167. 
      • Silaste M-L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesaniemi YA. Dietary and other non-pharmacological treatments in patients with drug-treated hypertension and control subjects. Journal of Internal Medicine. 2000; 247: 318-324.
      • Wu G, Tian H, Han K, Xi Y, Yao Y, Ma A. Potassium magnesium supplementation for four weeks improves small distal artery compliance and reduces blood pressure in patients with essential hypertension. Clin Exp Hypertens. 2006; 28 (5): 489-497.
      • Zhao L, Stamler J, Yan LL, Zhou B, Wu Y, Liu K, Daviglus ML, Dennis BH, Elliott P, Ueshima H, Yang J, Zhu L, Guo D, for the INTERMAP Research Group. Blood pressure differences between northern and southern Chinese: role of dietary factors. The international study on macronutrients and blood pressure. Hypertension, 2004; 43 (6): 1,332-1,337.
  • Search Plan and Results: Potassium 2005
     
  What is the relationship between sodium intake and blood pressure in healthy and hypertensive adults?

  • Conclusion

    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
    • 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.
  • Evidence Summary: What evidence suggests a relationship between sodium intake and blood pressure in healthy and hypertensive adults?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Appel LJ, Espeland MA, Easter L, Wilson AC, Folmar S, Lacy CR. Effects of reduced sodium intake on hypertension control in older individuals:  results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med. 2001 Mar 12; 161 (5): 685-693.
      • Cheung BMY, Ho SPC, Cheung AHK, Lau CP. Diastolic blood pressure is related to urinary sodium excretion in hypertensive Chinese patients.  Q J Med. 2000; 93: 163-168.
      • Espeland MA, Kumanyika S, Yunis C, Zheng B, Brown WM, Jackson S, Wilson AC, Bahnson J, Electrolyte intake and nonpharmacologic blood pressure control. Ann Epidemiol. 2002; 12: 587-595. 
      • Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. Journal of Human Hypertension, 2003; 17: 471-480.
      • Geleijnse JM, Kok FJ, Grobbee DE. Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. Eur J Public Health. 2004; 14 (3): 235-239. 
      • Hajjar I, Kotchen T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: The NHANES III Data. J Nutr. 2003; 133: 211-214.
      • He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension, 2003; 42: 1,093-1,099.
      • He J, Whelton PK, Appel LJ, Charleston J, Klag MJ. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension, 2000; 35: 544-549.  
      • Hu G, Tian H. A comparison of dietary and non-dietary factors of hypertension and normal blood pressure in a Chinese population. Journal of Human Hypertension, 2001; 15: 487-493.
      • Khaw KT, Bingham S, Welch A, Luben R, O'Brien E, Wareham N, Day N. Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr. 2004; 80: 1,397-1,403. 
      • Kwok TCY, Chan TYK, Woo J. Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians. European Journal of Clinical Nutrition, 2003; 57: 299-304.
      • Lancaster KJ, Smiciklas-Wright H, Weltzel LB, Mitchell DC, Friedman JM, Jensen GL. Hypertension-related dietary patterns of rural older adults. Preventive Medicine, 2004; 38: 812-818.
      • Liu L, Liu L, Ding Y, Huang Z, He B, Sun S, Zhao G, Zhang H, Miki T, Mizushima S, Ikeda K, Nara Y, Yamori Y. Ethnic and environmental differences in various markers of dietary intake and blood pressure among Chinese Han and three other minority peoples of China: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. Hypertens Res. 2001; 24 (3): 315-322.
      • Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller III ER, Simons-Morton DG, Karanja N, Lin PH. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med. 2001; 344:3-10.
      • Schroder H, Schmelz E, Marrugat J. Relationship between diet and blood pressure in a representative Mediterranean population. Eur J Nutr. 2002; 41 (4): 161-167. 
      • Silaste M-L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesaniemi YA. Dietary and other non-pharmacological treatments in patients with drug-treated hypertension and control subjects. Journal of Internal Medicine. 2000; 247: 318-324.
      • Zhao L, Stamler J, Yan LL, Zhou B, Wu Y, Liu K, Daviglus ML, Dennis BH, Elliott P, Ueshima H, Yang J, Zhu L, Guo D, for the INTERMAP Research Group. Blood pressure differences between northern and southern Chinese: role of dietary factors. The international study on macronutrients and blood pressure. Hypertension, 2004; 43 (6): 1,332-1,337.
  • Search Plan and Results: Sodium 2005