Relation of dietary sodium (Salt) to blood pressure and its possible modulation by other dietary factors the intermap study

Jeremiah Stamler; Queenie Chan; Martha L. Daviglus; Alan R. Dyer; Linda Van Horn; Daniel B. Garside; Katsuyuki Miura; Yangfeng Wu; Hirotsugu Ueshima; Liancheng Zhao; Paul Elliott

doi:10.1161/HYPERTENSIONAHA.117.09928

Relation of dietary sodium (Salt) to blood pressure and its possible modulation by other dietary factors the intermap study

Jeremiah Stamler^*, Queenie Chan, Martha L. Daviglus, Alan R. Dyer, Linda Van Horn, Daniel B. Garside, Katsuyuki Miura, Yangfeng Wu, Hirotsugu Ueshima, Liancheng Zhao, Paul Elliott

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

86 Scopus citations

Abstract

Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium-BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium-BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium-BP-but not sodium/potassium-BP-relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium-BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension.

Original language	English (US)
Pages (from-to)	631-637
Number of pages	7
Journal	Hypertension
Volume	71
Issue number	4
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.117.09928
State	Published - 2018

Funding

The INTERMAP study (International Study on Macro/Micronutrients and Blood Pressure) is supported by grants R01-HL50490, R01-HL84228, and R01-HL135486 from the National Heart, Lung, and Blood Institute, National Institutes of Health (Bethesda, MD) and by national agencies in China, Japan (the Ministry of Education, Science, Sports, and Culture, Grant-in-Aid for Scientific Research [A], No. 090357003), and the United Kingdom (a project grant from the West Midlands National Health Service Research and Development and grant R2019EPH from the Chest, Heart and Stroke Association, Northern Ireland). P. Elliott is Director of the MRC-PHE Centre for Environment and Health and acknowledges support from the Medical Research Council and Public Health England (MR/L01341X/1). P. Elliott acknowledges support from the NIHR Biomedical Research Centre at Imperial College Healthcare NHS Trust and Imperial College London, the NIHR Health Protection Research Unit in Health Impact of Environmental Hazards (HPRU-2012–10141), the UK MEDical BIOinformatics partnership (UK MED-BIO) supported by the Medical Research Council (MR/ L01632X/1), and the UK Dementia Research Institute (UK DRI) at Imperial College London, funded by the Medical Research Council, Alzheimer’s Society and Alzheimer’s Research, United Kingdom.

Keywords

Blood pressure
Diet
Hypertension
Potassium
Sodium

ASJC Scopus subject areas

Internal Medicine

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10.1161/HYPERTENSIONAHA.117.09928

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title = "Relation of dietary sodium (Salt) to blood pressure and its possible modulation by other dietary factors the intermap study",

abstract = "Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium-BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium-BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium-BP-but not sodium/potassium-BP-relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium-BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension.",

keywords = "Blood pressure, Diet, Hypertension, Potassium, Sodium",

author = "Jeremiah Stamler and Queenie Chan and Daviglus, {Martha L.} and Dyer, {Alan R.} and {Van Horn}, Linda and Garside, {Daniel B.} and Katsuyuki Miura and Yangfeng Wu and Hirotsugu Ueshima and Liancheng Zhao and Paul Elliott",

note = "Publisher Copyright: {\textcopyright} 2018. American Heart Association, Inc.",

year = "2018",

doi = "10.1161/HYPERTENSIONAHA.117.09928",

language = "English (US)",

volume = "71",

pages = "631--637",

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AU - Stamler, Jeremiah

AU - Chan, Queenie

AU - Daviglus, Martha L.

AU - Dyer, Alan R.

AU - Van Horn, Linda

AU - Garside, Daniel B.

AU - Miura, Katsuyuki

AU - Wu, Yangfeng

AU - Ueshima, Hirotsugu

AU - Zhao, Liancheng

AU - Elliott, Paul

PY - 2018

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N2 - Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium-BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium-BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium-BP-but not sodium/potassium-BP-relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium-BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension.

AB - Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium-BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium-BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium-BP-but not sodium/potassium-BP-relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium-BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension.

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Relation of dietary sodium (Salt) to blood pressure and its possible modulation by other dietary factors the intermap study

Abstract

Funding

Keywords

ASJC Scopus subject areas

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