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Salt, Hypertension, and Cardiovascular Disease

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Special Issues in Hypertension

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Abstract

Excess dietary salt intake has been justified for almost 5,000 years by the adoption of salt as a unique food preservative, a feature no longer required in modern times thanks to the availability of more advanced food preservation technologies. Nowadays, a persistently high salt intake depends mainly on its addition to foods during industrial processing or home food preparation with the aim to improve their organoleptic characteristics or simply meet the perceived current taste preference. The risks of a high-salt diet emerged quite clearly in the second half of the twentieth century with the demonstration of the causal association between habitual high-salt intake and the incidence of various chronic degenerative diseases, primarily hypertension and its severe cardiovascular complications. Recent meta-analyses of randomized controlled trials have convincingly shown the efficacy of even a moderate reduction in salt intake in reducing blood pressure both in hypertensive patients, to a degree proportional to the severity of hypertension, and in normotensive subjects of all age groups. The relationship between habitual salt intake and the incidence of cardiovascular events, primarily stroke, in turn demonstrated by the meta-analysis of prospective studies, is felt to be mainly a consequence of the greater incidence of hypertension. There is increasing evidence, however, that the adverse effects of excess dietary salt intake are also linked to atherogenic mechanisms, oxidative stress, and endothelial dysfunction, which produce structural and functional alterations of the arterial wall with subsequent organ damage. Taken together, these findings provide the bases for the recommendations made by the main scientific societies and by the World Health Organization in favor of the implementation of national strategies to reduce dietary salt intake at the population level through educational campaigns and negotiations with the food industry for appropriate food reformulation and progressive reduction of hidden salt in the food available to purchase.

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References

  1. Eaton SB, Konner M (1985) Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med 312:283–289

    Article  PubMed  CAS  Google Scholar 

  2. Cordain L, Eaton SB, Miller JB et al (2002) The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. Eur J Clin Nutr 56 Suppl1:S42–S52

    Google Scholar 

  3. Angus F (2007) Dietary salt intake: sources and targets for reduction. In: Kilcast D, Angus F (eds) Reducing salt in food. Woodhead Publishing Limited, Cambridge, pp 3–17

    Chapter  Google Scholar 

  4. World Health Organization (2007) Reducing salt intake in populations: report of a WHO forum and technical meeting. WHO Geneva, pp.1–60 (ISBN 978 92 4 1595377)

    Google Scholar 

  5. He FJ, MacGregor GA (2009) A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 23:363–384

    Article  PubMed  CAS  Google Scholar 

  6. Intersalt Cooperative Research Group: Intersalt: an international study of electrolyte excretion and blood pressure (1988) Results for 24–hour urinary sodium and potassium excretion. Br Med J 297: 319–328

    Google Scholar 

  7. Hofman A, Hazelbrock A, Valkenburg HA (1983) A randomized trial of sodium intake and blood pressure in newborn infants. JAMA 250:370–373

    Article  PubMed  CAS  Google Scholar 

  8. Geleijnse JM, Hofman A, Witteman JCM et al (1997) Long-term effects of neonatal sodium restriction on blood pressure. Hypertension 29:913–917

    Article  PubMed  CAS  Google Scholar 

  9. He FJ, Mac Gregor GA (2006) Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension 48:861–869

    Article  PubMed  CAS  Google Scholar 

  10. Denton D, Weisinger R, Mundy NI et al (1995) The effect of increased salt intake on blood pressure of chimpanzees. Nat Med 1:1009–1016

    Article  PubMed  CAS  Google Scholar 

  11. Svetkey LP, Sacks FM, Obarzanek E et al (1999) The DASH diet, sodium intake and blood pressure trial (DASH-sodium): rationale and design. DASH-sodium collaborative research group. J Am Diet Assoc 99(8 Suppl):S96–S104

    Article  PubMed  CAS  Google Scholar 

  12. He FJ, Mac Gregor GA (2004) Effect of longer-term modest salt reduction on blood pressure. Cochrane database of systematic reviews, Issue 1. Art. No.: CD004937

    Google Scholar 

  13. Pimenta E, Gaddam KK, Oparil S et al (2009) Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension results from a randomized trial. Hypertension 54:475–481

    Article  PubMed  CAS  Google Scholar 

  14. Strazzullo P, Galletti F, Dessì-Fulgheri P et al on behalf of the salt-sensitivity study group of the Italia Society of Hypertension (2000) Prediction and consistency of blood pressure salt-sensitivity as assessed by a rapid volume expansion and contraction protocol. J Nephrol 13: 46–53

    Google Scholar 

  15. Siani A, Guglielmucci G, Farinaro E et al (2000) Increasing evidence for the role of salt and salt-sensitivity in hypertension. Nutr Metab Cardiovasc Dis 10:93–100

    PubMed  CAS  Google Scholar 

  16. Strazzullo P, Barbato A, Vuotto P et al (2001) Relationships between salt-sensitivity of blood pressure and sympathetic nervous system activity: a short review of evidence. Clin Exp Hypertens 23:25–33

    Article  PubMed  CAS  Google Scholar 

  17. Strazzullo P, Barba G, Cappuccio FP et al (2001) Altered renal sodium handling in men with abdominal adiposity and insulin resistance: a link to hypertension. J Hypertens 19:2157–2164

    Article  PubMed  CAS  Google Scholar 

  18. Strazzullo P, Barbato A, Galletti F et al (2006) Abnormalities of renal sodium handling in the metabolic syndrome. Results of the olivetti Heart Study. J Hypertens 24:1633–1639

    Article  PubMed  CAS  Google Scholar 

  19. Chen J, Gu D, Huang J et al (2009) Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet 373:829–835

    Article  PubMed  CAS  Google Scholar 

  20. Rocchini AP, Key J, Bondie D et al (1989) The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. N Engl J Med 321:580–585

    Article  PubMed  CAS  Google Scholar 

  21. Venezia A, Barba G, Russo O et al (2010) Dietary sodium intake in a sample of adult male population in southern Italy: results of the olivetti heart study. Eur J Clin Nutr 64:518–524

    Article  PubMed  CAS  Google Scholar 

  22. Tunstall-Pedoe H, Woodward M, Tavendale R et al (1997) Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study. BMJ 315:722–729

    Article  PubMed  CAS  Google Scholar 

  23. Geleijnse JM, Witteman JC, Stijnen T et al (2007) Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam study. Eur J Epidemiol 22:763–770

    Article  PubMed  CAS  Google Scholar 

  24. Alderman MH, Cohen H, Madhavan S (1998) Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey (NHANES I). Lancet 351:781–785

    Article  PubMed  CAS  Google Scholar 

  25. He J, Ogden LG, Vupputuri S et al (1999) Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 282:2027–2034

    Article  PubMed  CAS  Google Scholar 

  26. Cohen HW, Hailpern SM, Fang J, et al (2006) Sodium intake and mortality in the NHANES II follow-up study. Am J Med 119:275 e7–14

    Google Scholar 

  27. Tuomilehto J, Jousilahti P, Rastenyte D et al (2001) Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet 357:848–851

    Article  PubMed  CAS  Google Scholar 

  28. The Trials of Hypertension Prevention Collaborative Research Group (1992) The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the trials of hypertension prevention, phase I. JAMA 267:1213–1220

    Google Scholar 

  29. TOHP II Trials of Hypertension Prevention Collaborative Research Group (1997) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The trials of hypertension prevention, phase II. The trials of hypertension prevention collaborative research group. Arch Intern Med 157:657–667

    Google Scholar 

  30. Cook NR, Cutler JA, Obarzanek E et al (2007) Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 334:885

    Article  PubMed  Google Scholar 

  31. Kagan A, Popper JS, Rhoads GG et al (1985) Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke 16:390–396

    Article  PubMed  CAS  Google Scholar 

  32. Hu HH, Sheng WY, Chu FL et al (1992) Incidence of stroke in Taiwan. Stroke 23:1237–1241

    Article  PubMed  CAS  Google Scholar 

  33. Nagata C, Takatsuka N, Shimizu N et al (2004) Sodium intake and risk of death from stroke in Japanese men and women. Stroke 35:1543–1547

    Article  PubMed  Google Scholar 

  34. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP (2009) Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 339:b4567

    Article  PubMed  Google Scholar 

  35. Tobian L, Hanlon S (1990) High sodium chloride diets injure arteries and raise mortality without changing blood pressure. Hypertension 15:900–903

    Article  PubMed  CAS  Google Scholar 

  36. Koga Y, Hirooka Y, Araki S et al (2008) High salt intake enhances blood pressure increase during development of hypertension via oxidative stress in rostral ventrolateral medulla of spontaneously hypertensive rats. Hypertens Res 31:2075–2083

    Article  PubMed  CAS  Google Scholar 

  37. Oberleithner H, Riethmuller C, Schillers H et al (2007) Plasma sodium stiffens vascular endothelium and reduces nitric oxide release. Proc Natl Acad Sci U S A 104:16281–16286

    Article  PubMed  CAS  Google Scholar 

  38. Dickinson KM, Keogh JB, Clifton PM (2009) Effects of a low-salt diet on flow-mediated dilatation in humans. Am J Clin Nutr 89:485–490

    Article  PubMed  CAS  Google Scholar 

  39. Suckling RJ, He FJ, Markandu ND et al (2012) Dietary salt influences postprandial plasma sodium concentration and systolic blood pressure. Kidney Int 81:407–411

    Article  PubMed  CAS  Google Scholar 

  40. Kupari M, Koskinen P, Virolainen J (1994) Correlates of left ventricular mass in a population sample aged 36–37 years. Focus on lifestyle and salt intake. Circulation 89:1041–1050

    Article  PubMed  CAS  Google Scholar 

  41. Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD (1988) Dietary salt intake. A determinant of cardiac involvement in essential hypertension. Circulation 78:951–956

    Article  PubMed  CAS  Google Scholar 

  42. Jula AM, Karanko HM (1994) Effects on left ventricular hypertrophy of long-term nonpharmacological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation 89:1023–1031

    Article  PubMed  CAS  Google Scholar 

  43. Avolio AP, Clyde KM, Beard TC et al (1986) Improved arterial distensibility in normotensive subjects on a low salt diet. Arteriosclerosis 6:166–169

    Article  PubMed  CAS  Google Scholar 

  44. Avolio AP, Deng FQ, Li WQ et al (1985) Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation 71:202–210

    Article  PubMed  CAS  Google Scholar 

  45. Gates PE, Tanaka H, Hiatt WR, Seals DR (2004) Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension 44:35–41

    Article  PubMed  CAS  Google Scholar 

  46. He FJ, Marciniak M, Visagie E et al (2009) Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and asian mild hypertensives. Hypertension 54:482–488

    Article  PubMed  CAS  Google Scholar 

  47. Seals DR, Tanaka H, Clevenger CM et al (2001) Blood pressure reductions with exercise and sodium restriction in postmenopausal women with elevated systolic pressure: role of arterial stiffness. J Am Coll Cardiol 38:506–513

    Article  PubMed  CAS  Google Scholar 

  48. du Calair G, Ribstein J, Mimran A (2002) Dietary sodium and target organ damage in essential hypertension. Am J Hypertens 15:222–229

    Article  Google Scholar 

  49. Verhave JC, Hillege HL, Burgerhof JG et al (2004) Sodium intake affects urinary albumin excretion especially in overweight subjects. J Intern Med 256:324–330

    Article  PubMed  CAS  Google Scholar 

  50. Swift PA, Markandu ND, Sagnella GA et al (2005) Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension 46:308–312

    Article  PubMed  CAS  Google Scholar 

  51. Graudal NA, Hubeck-Graudal T, Jurgens G (2012) Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Cochrane Review). Am J Hypertens 25:1–15

    Article  PubMed  CAS  Google Scholar 

  52. He FJ, MacGregor GA (2002) Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens 16:761–770

    Article  PubMed  CAS  Google Scholar 

  53. Nickenig G, Strehlow K, Roeling J et al (1998) Salt induces vascular AT1 receptor overexpression in vitro and in vivo. Hypertension 31:1272–1277

    Article  PubMed  CAS  Google Scholar 

  54. Frohlich ED (2007) The salt conundrum: a hypothesis. Hypertension 50:161–166

    Article  PubMed  CAS  Google Scholar 

  55. Chang H-Y, Hu Y-W, Yue C-SJ et al (2006) Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 83:1289–1296

    PubMed  CAS  Google Scholar 

  56. Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  57. Forte JG, Miguel JM, Miguel MJ et al (1989) Salt and blood pressure: a community trial. J Hum Hypertens 3:179–184

    PubMed  CAS  Google Scholar 

  58. Laatikainen T, Pietinen P, Valsta L et al (2006) Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr 60:965–970

    Article  PubMed  CAS  Google Scholar 

  59. Bibbins-Domingo K, Chertow GM, Coxson PG et al (2010) Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 362:590–599

    Article  PubMed  CAS  Google Scholar 

  60. Palar K, Sturm R (2009) Potential societal savings from reduced sodium consumption in the US adult population. Am J Health Promot 24:49–57

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Federico II University of Naples Medical School, Naples, Italy

    Pasquale Strazzullo, Ferruccio Galletti & Ivana Savino

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  1. Pasquale Strazzullo
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  2. Ferruccio Galletti
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  3. Ivana Savino
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Correspondence to Pasquale Strazzullo .

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Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

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Strazzullo, P., Galletti, F., Savino, I. (2012). Salt, Hypertension, and Cardiovascular Disease. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_12

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  • DOI: https://doi.org/10.1007/978-88-470-2601-8_12

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