Sodium

NA: Effect on Blood Pressure (2009)

Sodium and Effect on Blood Pressure

• Assessment
  Is there a relationship between sodium intake and blood pressure in African Americans?

  • Conclusion

    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
    • 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: Sodium Intake and Blood Pressure in African Americans
    • 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.
      • Bray GA, Vollmer WM, Sacks FM, Obarzanek E, Svetkey LP, Appel LJ. A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: Results of the DASH-sodium trial. AM J Cardiol. 204 Jul 15; 94(2): 222-227.
      • Chrysant SG, Weir MR, Weder AB, McCarron DA, Canossa-Terris M, Cohen JD, Mennella RF, Kirkegaard LW, Lewin AJ, Weinberger MH. There are no racial, age, sex, or weight differences in the effect of salt on blood pressure in salt-sensitive hypertensive patients. Arch Intern Med. 1997 Nov 24; 157 (21): 2,489-2,494.
      • He FJ, Markandu ND, Sagnella GA, MacGregor GA. Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension. 1998 Nov; 32(5): 820-824.
      • 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.
      • Wright JT Jr, Rahman M, Scarpa A, Fatholahi M, Griffin V, Jean-Baptiste R, Islam M, Eissa M, White S, Douglas JG. Determinants of salt sensitivity in black and white normotensive and hypertensive women. Hypertension. 2003 Dec; 42 (6): 1,087-1,092. Epub 2003 Nov 10.
  • Search Plan and Results: NA: Sodium Intake and Effect on Blood Pressure 2008
     
  Is there a relationship between sodium intake and blood pressure in children (2-18 years)?

  • Conclusion

    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
    • 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: Sodium Intake and Blood Pressure in Children (2-18 years)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • He Fj, MacGregor GA. Importance of salt in determining blood pressure in children: Meta-anaylsis of controlled trials. Hypertension. 2006; 48: 861-869.
      • He FJ, Marrero NM, MacGregor GA. Salt and blood pressure in children and adolescents. J Hum Hypertens. 2008 Jan; 22 (1): 4-11.
      • Maldonado-Martin A, Garcia-Matarin L, Gil-Extremera B, Avivar-Oyonarte C, Garcia-Granados ME, Gil-Garcia, F, Latorre-Hernandez J, Miro-Gutierrez J, Soria-Bonilla A, Vergara-Martin J, Javier-Martinez MR. Blood pressure and urinary excretion of electrolytes in Spanish schoolchildren.  J Hum Hypertens. 2002 Jul; 16 (7): 473-478.
      • Pomeranz A, Korzets Z, Vanunu D, Krystal H, Wolach B. Elevated Salt and Nitrate Levels in Drinking Water Cause an Increase of Blood Pressure in Schoolchildren. Kidney Blood Pressure Res. 2000; 23 (6): 400-403.
      • Ye T, Liu Z, Mu J, Fu X, Yang J, Gao B, Zhang X. Blood pressure change with age in salt-sensitive teenagers. Pediatr Nephrol. 2003; 18: 431-434
  • Search Plan and Results: NA: Sodium Intake and Effect on Blood Pressure 2008
     
  Is there a relationship between sodium intake and blood pressure in Asian Americans?

  • Conclusion

    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: 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: Sodium Intake and Blood Pressure in Asians
    • 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.
      • 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.
      • 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.
      • 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.
      • Radhika G, Sathya RM, Sudha V, et al. Dietary salt intake and hypertension in an urban south Indian population. J Assoc Physicians India. 2007; 55: 405-411.
      • Yoshida M, Koyama H, et al. Daily response of blood pressure to day-to-day variation of urinary sodium to potassium ratio. Clin Exp Hypertens. 1999 21: 1,189-1,202
      • 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.
    • Related Topics
  • Search Plan and Results: NA: Sodium Intake and Effect on Blood Pressure 2008
     
  Is there a relationship between sodium intake and blood pressure in Hispanics?

  • Conclusion

    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: III
    • 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: Sodium Intake and Blood Pressure in Hispanics
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Chrysant SG, Weir MR, Weder AB, McCarron DA, Canossa-Terris M, Cohen JD, Mennella RF, Kirkegaard LW, Lewin AJ, Weinberger MH. There are no racial, age, sex, or weight differences in the effect of salt on blood pressure in salt-sensitive hypertensive patients. Arch Intern Med. 1997 Nov 24; 157 (21): 2,489-2,494.
  • Search Plan and Results: NA: Sodium Intake and Effect on Blood Pressure 2008