Progress in Cardiovascular Diseases
Volume 52, Issue 5 , Pages 363-382 , March 2010

Reducing Population Salt Intake Worldwide: From Evidence to Implementation

  • Feng J. He

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Feng He, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom.
  • ,
  • Graham A. MacGregor

References 

  1. Brown IJ, Tzoulaki I, Candeias V, et al. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791–813
  2. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ. 1988;297:319–328
  3. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–384
  4. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334:885
  5. Tuomilehto J, Jousilahti P, Rastenyte D, et al. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet. 2001;357:848–851
  6. Cianciaruso B, Bellizzi V, Minutolo R, et al. Salt intake and renal outcome in patients with progressive renal disease. Miner Electrolyte Metab. 1998;24:296–301
  7. Heeg JE, de Jong PE, van der Hem GK, et al. Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int. 1989;36:272–279
  8. Swift PA, Markandu ND, Sagnella GA, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension. 2005;46:308–312
  9. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens. 1992;6:23–25
  10. Nagata C, Takatsuka N, Shimizu N, et al. Sodium intake and risk of death from stroke in Japanese men and women. Stroke. 2004;35:1543–1547
  11. Kupari M, Koskinen P, Virolainen J. Correlates of left ventricular mass in a population sample aged 36 to 37 years. Focus on lifestyle and salt intake. Circulation. 1994;89:1041–1050
  12. He FJ, Markandu ND, Sagnella GA, et al. Effect of salt intake on renal excretion of water in humans. Hypertension. 2001;38:317–320
  13. He FJ, Marrero NM, MacGregor GA. Salt intake is related to soft drink consumption in children and adolescents: a link to obesity?. Hypertension. 2008;51:629–634
  14. Cappuccio FP, Kalaitzidis R, Duneclift S, et al. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Nephrol. 2000;13:169–177
  15. Burney P. A diet rich in sodium may potentiate asthma. Epidemiologic evidence for a new hypothesis. Chest. 1987;91:143S–148S
  16. Tsugane S, Sasazuki S, Kobayashi M, et al. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. Br J Cancer. 2004;90:128–134
  17. Lewington S, Clarke R, Qizilbash N, et al. 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. 2002;360:1903–1913
  18. Denton D, Weisinger R, Mundy NI, et al. The effect of increased salt intake on blood pressure of chimpanzees. Nat Med. 1995;1:1009–1016
  19. Elliott P, Walker LL, Little MP, et al. Change in salt intake affects blood pressure of chimpanzees: implications for human populations. Circulation. 2007;116:1563–1568
  20. Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell. 2001;104:545–556
  21. Page LB, Damon A, Moellering RC. Antecedents of cardiovascular disease in six Solomon Islands societies. Circulation. 1974;49:1132–1146
  22. Uzodike VO: Epidemiological studies of arterial blood pressure and hypertension in relation to electrolyte excretion in three Igbo communities in Nigeria. Thesis (MD), University of London, 1993.
  23. Page LB, Vandevert DE, Nader K, et al. Blood pressure of Qash'qai pastoral nomads in Iran in relation to culture, diet, and body form. Am J Clin Nutr. 1981;34:527–538
  24. Elliott P, Stamler J. Evidence on salt and blood pressure is consistent and persuasive. Int J Epidemiol. 2002;31:316–319
  25. Elliott P, Stamler J, Nichols R, et al. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ. 1996;312:1249–1253
  26. Zhou BF, Stamler J, Dennis B, et al. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens. 2003;17:623–630
  27. Khaw KT, Bingham S, Welch A, et al. 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;80:1397–1403
  28. He J, Klag MJ, Whelton PK, et al. Migration, blood pressure pattern, and hypertension: the Yi Migrant Study. Am J Epidemiol. 1991;134:1085–1101
  29. Poulter NR, Khaw KT, Hopwood BE, et al. The Kenyan Luo migration study: observations on the initiation of a rise in blood pressure. BMJ. 1990;300:967–972
  30. Forte JG, Miguel JM, Miguel MJ, et al. Salt and blood pressure: a community trial. J Hum Hypertens. 1989;3:179–184
  31. Tian HG, Guo ZY, Hu G, et al. Changes in sodium intake and blood pressure in a community-based intervention project in China. J Hum Hypertens. 1995;9:959–968
  32. Staessen J, Bulpitt CJ, Fagard R, et al. Salt intake and blood pressure in the general population: a controlled intervention trial in two towns. J Hypertens. 1988;6:965–973
  33. Tuomilehto J, Puska P, Nissinen A, et al. Community-based prevention of hypertension in North Karelia, Finland. Ann Clin Res. 1984;16(Suppl 43):18–27
  34. Takahashi Y, Sasaki S, Okubo S, et al. Blood pressure change in a free-living population-based dietary modification study in Japan. J Hypertens. 2006;24:451–458
  35. Kempner W. Treatment of hypertensive vascular disease with rice diet. Am J Med. 1948;26:545–577
  36. MacGregor GA, Markandu ND, Best FE, et al. Double-blind randomised crossover trial of moderate sodium restriction in essential hypertension. Lancet. 1982;319:351–355
  37. Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III-Analysis of data from trials of salt reduction. BMJ. 1991;302:819–824
  38. Midgley JP, Matthew AG, Greenwood CM, et al. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 1996;275:1590–1597
  39. Cutler JA, Follmann D, Allender PS. Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997;65:643S–651S
  40. Graudal NA, Galloe AM, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998;279:1383–1391
  41. Hooper L, Bartlett C, Davey Smith G, et al. Systematic review of long term effects of advice to reduce dietary salt in adults. BMJ. 2002;325:628–632
  42. He FJ, Markandu ND, MacGregor GA. Importance of the renin system for determining blood pressure fall with acute salt restriction in hypertensive and normotensive whites. Hypertension. 2001;38:321–325
  43. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002;16:761–770
  44. MacGregor GA, Markandu ND, Sagnella GA, et al. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989;334:1244–1247
  45. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3–10
  46. Hofman A, Hazebroek A, Valkenburg HA. A randomized trial of sodium intake and blood pressure in newborn infants. JAMA. 1983;250:370–373
  47. Heird WC, Ziegler P, Reidy K, et al. Current electrolyte intakes of infants and toddlers. J Am Diet Assoc. 2006;106:S43–S51
  48. Geleijnse JM, Hofman A, Witteman JC, et al. Long-term effects of neonatal sodium restriction on blood pressure. Hypertension. 1997;29:913–917
  49. Simons-Morton DG, Obarzanek E. Diet and blood pressure in children and adolescents. Pediatr Nephrol. 1997;11:244–249
  50. He FJ, Marrero NM, Macgregor GA. Salt and blood pressure in children and adolescents. J Hum Hypertens. 2008;22:4–11
  51. Cooper R, Soltero I, Liu K, et al. The association between urinary sodium excretion and blood pressure in children. Circulation. 1980;62:97–104
  52. He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension. 2006;48:861–869
  53. Lauer RM, Clarke WR. Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics. 1989;84:633–641
  54. De Courcy S, Mitchell H, Simmons D, et al. Urinary sodium excretion in 4-6 year old children: a cause for concern?. Br Med J (Clin Res Ed). 1986;292:1428–1429
  55. St-Onge MP, Keller KL, Heymsfield SB. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr. 2003;78:1068–1073
  56. He FJ, Markandu ND, Sagnella GA, et al. Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension. 1998;32:820–824
  57. Cappuccio FP, Markandu ND, Carney C, et al. Double-blind randomised trial of modest salt restriction in older people. Lancet. 1997;350:850–854
  58. Alam S, Johnson AG. A meta-analysis of randomised controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure. J Hum Hypertens. 1999;13:367–374
  59. Vollmer WM, Sacks FM, Ard J, et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. 2001;135:1019–1028
  60. He FJ, MacGregor GA. Salt, blood pressure and the renin-angiotensin system. J Renin Angiotensin Aldosterone Syst. 2003;4:11–16
  61. Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288:1882–1888
  62. Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839–846
  63. The Trials of Hypertension Prevention Collaborative Research Group. 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. Arch Intern Med. 1997;157:657–667
  64. MacGregor GA, Markandu ND, Singer DR, et al. Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study. Br Med J (Clin Res Ed). 1987;294:531–534
  65. Appel LJ, Espeland MA, Easter L, et al. 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;161:685–693
  66. Pimenta E, Gaddam KK, Oparil S, et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension. Results from a randomized trial. Hypertension. 2009;54:475–481
  67. Dahl LK, Heine M, Thompson K. Genetic influence of renal homografts on the blood pressure of rats from different strains. Proc Soc Exp Biol Med. 1972;140:852–856
  68. Dahl LK, Heine M, Thompson K. Genetic influence of the kidneys on blood pressure. Evidence from chronic renal homografts in rats with opposite predispositions to hypertension. Circ Res. 1974;40:94–101
  69. Curtis JJ, Luke RG, Dustan HP, et al. Remission of essential hypertension after renal transplantation. N Engl J Med. 1983;309:1009–1015
  70. Guyton AC. Blood pressure control-special role of the kidneys and body fluids. Science. 1991;252:1813–1816
  71. He FJ, Markandu ND, Sagnella GA, et al. Plasma sodium: ignored and underestimated. Hypertension. 2005;45:98–102
  72. Bulpitt CJ, Shipley MJ, Semmence A. Blood pressure and plasma sodium and potassium. Clin Sci (Lond). 1981;61(Suppl 7):85s–87s
  73. Komiya I, Yamada T, Takasu N, et al. An abnormal sodium metabolism in Japanese patients with essential hypertension, judged by serum sodium distribution, renal function and the renin-aldosterone system. J Hypertens. 1997;15:65–72
  74. Wannamethee G, Whincup PH, Shaper AG, et al. Serum sodium concentration and risk of stroke in middle-aged males. J Hypertens. 1994;12:971–979
  75. Lago RM, Pencina MJ, Wang TJ, et al. Interindividual variation in serum sodium and longitudinal blood pressure tracking in the Framingham Heart Study. J Hypertens. 2008;26:2121–2125
  76. de Wardener HE, He FJ, MacGregor GA. Plasma sodium and hypertension. Kidney Int. 2004;66:2454–2466
  77. Friedman SM, McIndoe RA, Tanaka M. The relation of blood sodium concentration to blood pressure in the rat. J Hypertens. 1990;8:61–66
  78. Friedman SM. The relation of cell volume, cell sodium and the transmembrane sodium gradient to blood pressure. J Hypertens. 1990;8:67–73
  79. Gu J, Anand V, Shek E, et al. Sodium induces hypertrophy of cultured myocardial myoblasts and vascular smooth muscle cells. Hypertension. 1998;31:1083–1087
  80. Li J, White J, Guo L, et al. Salt inactivates endothelial nitric oxide synthase in endothelial cells. J Nutr. 2009;139:447–451
  81. Oberleithner H, Riethmuller C, Schillers H, et al. Plasma sodium stiffens vascular endothelium and reduces nitric oxide release. PNAS. 2007;104:16281–16286
  82. Dickinson KM, Keogh JB, Clifton PM. Effects of a low-salt diet on flow-mediated dilatation in humans. Am J Clin Nutr. 2009;89:485–490
  83. Tzemos N, Lim PO, Wong S, et al. Adverse Cardiovascular Effects of Acute Salt Loading in Young Normotensive Individuals. Hypertension. 2008;51:1525–1530
  84. He FJ, MacGregor GA. How far should salt intake be reduced?. Hypertension. 2003;42:1093–1099
  85. Antonios TF, MacGregor GA. Salt-more adverse effects. Lancet. 1996;348:250–251
  86. Sasaki N. The salt factor in apoplexy and hypertension: epidemiological studies in Japan. In: Yamori Y editors. Prophylactic approach to hypertensive diseases. New York: Raven Press; 1979;p. 467–474
  87. Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis. 2006;49:59–75
  88. Laatikainen T, Pietinen P, Valsta L, et al. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006;60:965–970
  89. Kagan A, Popper JS, Rhoads GG, et al. Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke. 1985;16:390–396
  90. Alderman MH, Madhavan S, Cohen H, et al. Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension. 1995;25:1144–1152
  91. Stamler J, Cohen J, Culter JA, et al. Sodium intake and mortality from myocardial infarction: multiple risk factor intervention trial (MRFIT). Can J Cardiol. 1997;13(Suppl B):272B
  92. Tunstall-Pedoe H, Woodward M, Tavendale R, et al. 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. 1997;315:722–729
  93. He J, Ogden LG, Vupputuri S, et al. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA. 1999;282:2027–2034
  94. Alderman MH, Cohen H, Madhavan S. Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey (NHANES I). Lancet. 1998;351:781–785
  95. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98:1198–1204
  96. Cohen HW, Hailpern SM, Fang J, et al. Sodium intake and mortality in the NHANES II follow-up study. Am J Med 119:275. 2006;e277–214
  97. Cohen HW, Hailpern SM, Alderman MH. Sodium Intake and Mortality Follow-Up in the Third National Health and Nutrition Examination Survey (NHANES III). J Gen Intern Med. 2008;
  98. Geleijnse JM, Witteman JC, Stijnen T, et al. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study. Eur J Epidemiol. 2007;22:763–770
  99. Cook NR, Obarzanek E, Cutler JA, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med. 2009;169:32–40
  100. Karppanen H, Mervaala E. Sodium intake and mortality. Lancet. 1998;351:1509
  101. Meltzer JI. Low urinary sodium and myocardial infarction. Hypertension. 1996;27:156–157
  102. Chang HY, Hu YW, Yue CS, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr. 2006;83:1289–1296
  103. He J, Ogden LG, Bazzano LA, et al. Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Arch Intern Med. 2002;162:1619–1624
  104. MacGregor GA, de Wardener HE. Idiopathic edema. In:  Schrier RW,  Gottschalk CW editor. 6th ed. Diseases of the kidney. vol. III:Boston: Little Brown and Company; 1997;p. 2343–2352
  105. Tobian L, Hanlon S. High sodium chloride diets injure arteries and raise mortality without changing blood pressure. Hypertension. 1990;15:900–903
  106. Xie JX, Sasaki S, Joossens JV, et al. The relationship between urinary cations obtained from the INTERSALT study and cerebrovascular mortality. J Hum Hypertens. 1992;6:17–21
  107. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–1566
  108. Schmieder RE, Messerli FH, Garavaglia GE, et al. Dietary salt intake. A determinant of cardiac involvement in essential hypertension. Circulation. 1988;78:951–956
  109. Du Cailar G, Ribstein J, Daures JP, et al. Sodium and left ventricular mass in untreated hypertensive and normotensive subjects. Am J Physiol. 1992;263:H177–H181
  110. Ferrara LA, de Simone G, Pasanisi F, et al. Left ventricular mass reduction during salt depletion in arterial hypertension. Hypertension. 1984;6:755–759
  111. Liebson PR, Grandits GA, Dianzumba S, et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation. 1995;91:698–706
  112. Jula AM, Karanko HM. Effects on left ventricular hypertrophy of long-term nonpharmacological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation. 1994;89:1023–1031
  113. Joossens JV, Hill MJ, Elliott P, et al. Dietary salt, nitrate and stomach cancer mortality in 24 countries. European Cancer Prevention (ECP) and the INTERSALT Cooperative Research Group. Int J Epidemiol. 1996;25:494–504
  114. Beevers DG, Lip GY, Blann AD. Salt intake and Helicobacter pylori infection. J Hypertens. 2004;22:1475–1477
  115. Forman D, Newell DG, Fullerton F, et al. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991;302:1302–1305
  116. Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA. 2004;291:187–194
  117. Arnlov J, Evans JC, Meigs JB, et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation. 2005;112:969–975
  118. du Cailar G, Ribstein J, Mimran A. Dietary sodium and target organ damage in essential hypertension. Am J Hypertens. 2002;15:222–229
  119. Verhave JC, Hillege HL, Burgerhof JG, et al. Sodium intake affects urinary albumin excretion especially in overweight subjects. J Intern Med. 2004;256:324–330
  120. He FJ, Marciniak M, Visagie E, et al. Effect of modest salt reduction on blood pressure, urinary albumin, and pulse wave velocity in white, black, and Asian mild hypertensives. Hypertension. 2009;54:482–488
  121. Houlihan CA, Allen TJ, Baxter AL, et al. A low-sodium diet potentiates the effects of losartan in type 2 diabetes. Diabetes Care. 2002;25:663–671
  122. Matkovic V, Ilich JZ, Andon MB, et al. Urinary calcium, sodium, and bone mass of young females. Am J Clin Nutr. 1995;62:417–425
  123. Lin PH, Ginty F, Appel LJ, et al. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr. 2003;133:3130–3136
  124. Devine A, Criddle RA, Dick IM, et al. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr. 1995;62:740–745
  125. Mickleborough TD, Fogarty A. Dietary sodium intake and asthma: an epidemiological and clinical review. Int J Clin Pract. 2006;60:1616–1624
  126. Carey OJ, Locke C, Cookson JB. Effect of alterations of dietary sodium on the severity of asthma in men. Thorax. 1993;48:714–718
  127. Mickleborough TD, Lindley MR, Ray S. Dietary salt, airway inflammation, and diffusion capacity in exercise-induced asthma. Med Sci Sports Exerc. 2005;37:904–914
  128. Pogson ZE, Antoniak MD, Pacey SJ, et al. Does a low sodium diet improve asthma control? A randomized controlled trial. Am J Respir Crit Care Med. 2008;178:132–138
  129. Corbo GM, Forastiere F, Sario MD, et al. Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet. Epidemiology. 2008;19:747–755
  130. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97:667–675
  131. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357:505–508
  132. James J, Thomas P, Cavan D, et al. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ. 2004;328:1237
  133. Beckmann SL, Os I, Kjeldsen SE, et al. Effect of dietary counselling on blood pressure and arterial plasma catecholamines in primary hypertension. Am J Hypertens. 1995;8:704–711
  134. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–2997
  135. Grey A, Braatvedt G, Holdaway I. Moderate dietary salt restriction does not alter insulin resistance or serum lipids in normal men. Am J Hypertens. 1996;9:317–322
  136. Townsend RR, Kapoor S, McFadden CB. Salt intake and insulin sensitivity in healthy human volunteers. Clin Sci (Lond). 2007;113:141–148
  137. Meland E, Laerum E, Aakvaag A, et al. Salt restriction: effects on lipids and insulin production in hypertensive patients. Scand J Clin Lab Invest. 1997;57:501–505
  138. Hu G, Jousilahti P, Peltonen M, et al. Urinary sodium and potassium excretion and the risk of type 2 diabetes: a prospective study in Finland. Diabetologia. 2005;48:1477–1483
  139. Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension. 2006;48:219–224
  140. He FJ, MacGregor GA. Beneficial effects of potassium on human health. Physiol Plant. 2008;133:725–735
  141. Singer DR, Markandu ND, Cappuccio FP, et al. Reduction of salt intake during converting enzyme inhibitor treatment compared with addition of a thiazide. Hypertension. 1995;25:1042–1044
  142. Selmer RM, Kristiansen IS, Haglerod A, et al. Cost and health consequences of reducing the population intake of salt. J Epidemiol Community Health. 2000;54:697–702
  143. Joffres MR, Campbell NR, Manns B, et al. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23:437–443
  144. Asaria P, Chisholm D, Mathers C, et al. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044–2053
  145. Murray CJ, Lauer JA, Hutubessy RC, et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003;361:717–725
  146. Scientific Advisory Committee on Nutrition, Salt and health . The Stationery Office. Available at http://www.sacn.gov.uk/pdfs/sacn_salt_final.pdf2003;(Access verified August 7 2008)
  147. Dietary Guidelines for Americans. http://www.health.gov/DietaryGuidelines/dga2005/document/default.htm2005;(Accessed January 28, 2009)
  148. Joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases. 2002. Geneva. Available at http://www.who.int/hpr/NPH/docs/who_fao_experts_report.pdf(Accessed October 30, 2008)
  149. Reducing salt intake in population . WHO Forum and Technical Meeting on Reducing Salt Intake in Populations. http://www.who.int/dietphysicalactivity/reducingsalt/en/index.html(Access verified August 7 2008)
  150. WHO Regional Office for Europe . Nutrition and food security. Action networks. http://test.cp.euro.who.int/eprise/main/WHO/Progs/NUT/ActionPlan/20080516_1(Access verified 7 August 2008)
  151. Consensus Action on Salt and Health. http://www.actiononsalt.org.uk(Accessed August 7 2008)
  152. MacGregor GA, Sever PS. Salt-overwhelming evidence but still no action: can a consensus be reached with the food industry? CASH (Consensus Action on Salt and Hypertension). BMJ. 1996;312:1287–1289
  153. Henderson L, Irving K, Gregory J, et al. National Diet and Nutrition Survey: Adults Aged 19 to 64. In: Vitamin and Mineral Intake and Urinary Analytes. Vol 3:London, England: TSO; 2003;p. 127–136
  154. Food Standards Agency . Agency publishes 2012 salt reduction targets. Monday 18 May 2009 http://www.food.gov.uk/news/newsarchive/2009/may/salttargets(Accessed July 8, 2009)
  155. Girgis S, Neal B, Prescott J, et al. A one-quarter reduction in the salt content of bread can be made without detection. Eur J Clin Nutr. 2003;57:616–620
  156. Food Standards Agency . Dietary sodium levels surveys. Tuesday 22 July 2008. Available at http://www.food.gov.uk/science/dietarysurveys/urinary(Accessed August 4, 2008)
  157. Food Standards Agency . Traffic Light Labelling. Available at http://www.eatwell.gov.uk/foodlabels/trafficlights/(Accessed March 22, 2008)
  158. Pietinen P, Valsta LM, Hirvonen T, et al. Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland. Public Health Nutr. 2008;11:335–340
  159. World Action on Salt and Health. Press release-Medical experts launch global campaign against salt to prevent over 2.5 million deaths worldwide each year. Available at http://www.worldactiononsalt.com/media/Media_coverage/Archive_Wash_Launch.htm(Accessed April 29, 2008)
  160. Mohan S, Campbell NR. Salt and high blood pressure. Clin Sci (Lond). 2009;117:1–11
  161. CSPI Sues FDA to Force End to 20-Year Delay in Regulating Salt. http://www.cspinet.org/new/200502242.html(Accessed June 12, 2008)
  162. Dickinson BD, Havas S. Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the Council on Science and Public Health. Arch Intern Med. 2007;167:1460–1468
  163. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–1518
  164. James WP, Ralph A, Sanchez-Castillo CP. The dominance of salt in manufactured food in the sodium intake of affluent societies. Lancet. 1987;1:426–429

 Statement of Conflict of Interest: see page 378.

PII: S0033-0620(09)00127-3

doi: 10.1016/j.pcad.2009.12.006

Progress in Cardiovascular Diseases
Volume 52, Issue 5 , Pages 363-382 , March 2010