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Tommaso Filippini, Marcella Malavolti, Paul Kieran Whelton, Androniki Naska, Nicola Orsini, Marco Vinceti
BACKGROUND: The relationship between dietary sodium intake and blood pressure (BP) has been tested in clinical trials and nonexperimental human studies, indicating a direct association. The exact shape of the dose-response relationship has been difficult to assess in clinical trials because of the lack of random-effects dose-response statistical models that can include 2-arm comparisons. METHODS: After performing a comprehensive literature search for experimental studies that investigated the BP effects of changes in dietary sodium intake, we conducted a dose-response meta-analysis using the new 1-stage cubic spline mixed-effects model. We included trials with at least 4 weeks of follow-up; 24-hour urinary sodium excretion measurements; sodium manipulation through dietary change or supplementation, or both; and measurements of systolic and diastolic BP at the beginning and end of treatment. RESULTS: We identified 85 eligible trials with sodium intake ranging from 0.4 to 7.6 g/d and follow-up from 4 weeks to 36 months. The trials were conducted in participants with hypertension (n=65), without hypertension (n=11), or a combination (n=9). Overall, the pooled data were compatible with an approximately linear relationship between achieved sodium intake and mean systolic as well as diastolic BP, with no indication of a flattening of the curve at either the lowest or highest levels of sodium exposure. Results were similar for participants with or without hypertension, but the former group showed a steeper decrease in BP after sodium reduction. Intervention duration (≥12 weeks versus 4 to 11 weeks), type of study design (parallel or crossover), use of antihypertensive medication, and participants' sex had little influence on the BP effects of sodium reduction. Additional analyses based on the BP effect of difference in sodium exposure between study arms at the end of the trial confirmed the results on the basis of achieved sodium intake. CONCLUSIONS: In this dose-response analysis of sodium reduction in clinical trials, we identified an approximately linear relationship between sodium intake and reduction in both systolic and diastolic BP across the entire range of dietary sodium exposure. Although this occurred independently of baseline BP, the effect of sodium reduction on level of BP was more pronounced in participants with a higher BP level.
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Filippini, T., Malavolti, M., Whelton, P. K., Naska, A., Orsini, N., & Vinceti, M. (2021). Blood Pressure Effects of Sodium Reduction. Circulation, 143(16), 1542–1567. https://doi.org/10.1161/circulationaha.120.050371
Filippini, Tommaso, et al. "Blood Pressure Effects of Sodium Reduction." Circulation, vol. 143, no. 16, 2021, pp. 1542–1567, https://doi.org/10.1161/circulationaha.120.050371.
Filippini, Tommaso, Marcella Malavolti, Paul Kieran Whelton, Androniki Naska, Nicola Orsini, and Marco Vinceti. "Blood Pressure Effects of Sodium Reduction." Circulation 143, no. 16 (2021): 1542–1567. https://doi.org/10.1161/circulationaha.120.050371.
Filippini T., Malavolti M., Whelton P. K. [и др.] Blood Pressure Effects of Sodium Reduction // Circulation. — 2021. — Vol. 143, № 16. — P. 1542–1567. — URL: https://doi.org/10.1161/circulationaha.120.050371
@article{filippini2021blood,
title = {{Blood Pressure Effects of Sodium Reduction}},
author = {Tommaso Filippini and Marcella Malavolti and Paul Kieran Whelton and Androniki Naska and Nicola Orsini and Marco Vinceti},
journal = {Circulation},
year = {2021},
volume = {143},
number = {16},
pages = {1542--1567},
doi = {10.1161/circulationaha.120.050371},
url = {https://doi.org/10.1161/circulationaha.120.050371}
}TY - JOUR AU - Filippini, Tommaso AU - Malavolti, Marcella AU - Whelton, Paul Kieran AU - Naska, Androniki AU - Orsini, Nicola AU - Vinceti, Marco TI - Blood Pressure Effects of Sodium Reduction JO - Circulation VL - 143 IS - 16 SP - 1542 EP - 1567 PY - 2021 DA - 2021/02/15 DO - 10.1161/circulationaha.120.050371 UR - https://doi.org/10.1161/circulationaha.120.050371 ER -
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