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(Hypertension. 1995;25:1153-1154.)
© 1995 American Heart Association, Inc.

Articles

An Unexpected Result For Sodium— Causal Or Casual?

Nancy R. Cook; Jeffrey A. Cutler; Charles H. Hennekens

From the Division of Preventive Medicine, Brigham and Women's Hospital (N.R.C., C.H.H.), Boston, Mass, and the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute (J.A.C.), Bethesda, Md.

Key Words: cardiovascular disease • hypertension, sodium-dependent • blood pressure • sodium • myocardial infarction

	Introduction

 
The study by Alderman et al¹ in the current issue of Hypertension provides data that raise a question of whether a decrease in sodium intake lowers risk of cardiovascular disease. The National High Blood Pressure Education Program Working Group² cited a reduction in sodium intake as one of the most effective approaches to preventing hypertension. They recommend a multifaceted approach to public education that includes limiting excess sodium intake as a key element. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure³ recommends lifestyle modifications, including sodium reduction, as a first-line treatment for mildly and moderately hypertensive individuals.

Much of the evidence concerning the benefit of a decrease in sodium intake is derived from studies of blood pressure. Observational data, from both between-population and within-population studies^{4 5} and particularly data from the INTERSALT study,^{6 7} show a consistent direct relationship of sodium excretion (U_NaV) to blood pressure. Current estimates from INTERSALT⁷ suggest a 100-mmol decrease in sodium is associated with a decrease in systolic pressure of 3.1 mm Hg.

Randomized trial data have generally supported these observational results.^{8 9} The recent Trials of Hypertension Prevention, Phase I¹⁰ found that decreases in systolic/diastolic pressures of 1.7/0.9 mm Hg were associated with average sodium decreases of about 44 mmol/24 h, a finding comparable to other trials among normotensive subjects.⁹ The results in trials among hypertensive subjects tend to be even stronger. An overview⁹ suggests decreases in systolic/diastolic pressures of 4.9/2.6 mm Hg in trials among hypertensive . . . [Full Text of this Article]

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