HYPERTENSION TREATED BY SALT RESTRICTION

doi:10.1016/S0140-6736(78)90479-8

The Lancet

Volume 311, Issue 8058, 4 February 1978, Pages 227-230

https://doi.org/10.1016/S0140-6736(78)90479-8 Get rights and content

Abstract

31 patients with a diastolic blood-pressure between 95 and 109 mm Hg have been treated for two years with a regimen involving a moderate restriction of salt in the diet. The results are compared with those in a control group and in a drug-treated group. Salt restriction has reduced the diastolic blood-pressure by 7·3±1·6 mm Hg, a result similar to that in patients treated with antihypertensive drugs. In the untreated group the diastolic blood-pressure rose by 1·8±1·1 mm Hg. Most patients did not achieve the desired amount of salt restriction and a stricter adherence to the diet might have caused further falls in blood-pressure. Excessive salt intake is probably a major cause of the epidemic of hypertension in "civilised" countries and a reduction in salt intake may help to control the epidemic. In persons with a diastolic blood-pressure between 90 and 105 mm Hg salt restriction should be tried before drugs.

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Cited by (254)

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Citation Excerpt :
Setting aside the problematic trials, the only interventional evidence we are left with on CVD is the long-term follow-up of participants who previously took part in salt-reduction trials (74,75). Pooling their results showed that salt reduction has a significant beneficial effect, with a 2.5 g/day reduction being associated with a 20% reduction in CVD events (Figure 5) (54,74,76–80). These findings provide further evidence in favor of salt reduction as a preventive public health measure against CVD.
There is strong evidence for a causal relationship between salt intake and blood pressure. Randomized trials demonstrate that salt reduction lowers blood pressure in both individuals who are hypertensive and those who are normotensive, additively to antihypertensive treatments. Methodologically robust studies with accurate salt intake assessment have shown that a lower salt intake is associated with a reduced risk of cardiovascular disease, all-cause mortality, and other conditions, such as kidney disease, stomach cancer, and osteoporosis. Multiple complex and interconnected physiological mechanisms are implicated, including fluid homeostasis, hormonal and inflammatory mechanisms, as well as more novel pathways such as the immune response and the gut microbiome. High salt intake is a top dietary risk factor. Salt reduction programs are cost-effective and should be implemented or accelerated in all countries. This review provides an update on the evidence relating salt to health, with a particular focus on blood pressure and cardiovascular disease, as well as the potential mechanisms.
Pathophysiological Links Between Diabetes and Blood Pressure
2018, Canadian Journal of Cardiology
Citation Excerpt :
The lack of renal adaptation in excreting the excess sodium leads to increased extracellular fluid volume, resulting in increased peripheral vascular resistance and hypertension.7 Interventional studies have shown the importance of sodium reduction for the treatment of hypertension in subjects with and without diabetes.8 However, results from epidemiological studies that examined the association between sodium intake and blood pressure (BP) in different populations have been controversial.
Hypertension is highly prevalent among people with diabetes, and the presence of diabetes among those with hypertension portends an increase in cardiovascular risk. In this review we aim to explore the pathophysiological links between diabetes and hypertension. Renal sodium handling differs in diabetes because there is an upregulation of sodium transporters in the kidneys. The renin-angiotensin-aldosterone system may be upregulated in diabetes, leading to hypertension through a direct effect mediated by angiotensin II, as well as indirectly through upregulation of sympathetic activity. Renin-angiotensin-aldosterone system blockade is a mainstay therapy for hypertension, and evidence suggests that it might also reduce the incidence of diabetes. People with diabetes frequently have autonomic dysfunction, which could contribute to hypertension through increased sympathetic tone and through stimulation of renin production in the juxtaglomerular apparatus. Furthermore, people with diabetes also frequently show an abnormality in their circadian blood pressure pattern. Another important link between hypertension and diabetes is the development as well as progression of diabetic kidney disease, the pathophysiology of which is mediated through several pathways including endothelial dysfunction and advanced glycation end products. Finally, obesity and the metabolic syndrome, through their effects on various hormones and inflammation, might also contribute to the pathogenesis of hypertension and diabetes.
L'hypertension est fortement prévalente chez les personnes atteintes de diabète, et la présence de diabète chez les personnes hypertendues laisse présager une augmentation du risque cardiovasculaire. L'objet de cette étude est d'explorer les liens physiopathologiques entre le diabète et l'hypertension. La prise en charge du sodium rénal diffère dans le diabète en raison de la régulation positive à laquelle sont soumis les transporteurs de sodium dans le rein. Le système rénine-angiotensine-aldostérone pourrait être régulé positivement dans le diabète et provoquer de l'hypertension à la fois par un effet direct médié par l'angiotensine II et indirectement par la régulation positive de l'activité sympathique. Le blocage du système rénine-angiotensine-aldostérone est un élément fondamental du traitement de l'hypertension et, d'après des données probantes, pourrait également réduire l'incidence du diabète. Les personnes atteintes de diabète présentent aussi souvent un dysfonctionnement du système nerveux autonome qui pourrait contribuer à l'hypertension par l'intermédiaire de la stimulation de la production de rénine dans l'appareil juxtaglomérulaire. De surcroît, les personnes atteintes de diabète présentent souvent une anomalie de leur profil de variation circadienne de la pression artérielle. Un autre lien important entre l'hypertension et le diabète est l'apparition et la progression de la néphropathie diabétique par plusieurs voies physiopathologiques, y compris la dysfonction endothéliale et les produits terminaux de la glycation. Enfin, par leurs effets sur différentes hormones et sur l'inflammation, l'obésité et le syndrome métabolique pourraient également jouer un rôle dans la pathogenèse de l'hypertension et du diabète.
Clinical Update on Nursing Home Medicine: 2012
2012, Journal of the American Medical Directors Association
Citation Excerpt :
A meta-analysis of trials of dietary sodium reduction longer than 6 months (removing one heart failure trial which included a very large, fixed dose of furosemide)29 found a relative risk of 0.8 (.64–.99) for CVD events in the lower sodium arm. The intervention arms did not achieve the target sodium goals but ranged from 2.3 gm sodium in the TONE22 to about 3.5 gm sodium in the small trial by Morgan.30,31 Neither the DASH, TONE, nor the Trial of Hypertension Prevention trials enrolled a substantial number of very old adults; none had dementia or were living in nursing homes.
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¹: Present address: Royal Newcastle Hospital, New South Wales 2308, Australia.

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HYPERTENSION TREATED BY SALT RESTRICTION

Abstract

Lancet

Am. J. Cardiol.

Am. J. Med.

Am. Heart J.

Blood Pressure Insurance Experience and its Implication

Q. Jl Med.

Am. J. Epidem.

Med. J. Aust.