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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Publisher: Cochrane Collaboration
Languages: English
Types: Article
Subjects:
Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear.\ud To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials.\ud The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions.\ud Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available.\ud Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed.\ud Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control.\ud Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

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    • Geleijnse 1995 {published data only} ∗ Geleijnse JM, Witteman JC, Bak AA, den BJ, Grobbee DE. Long-term moderate sodium restriction does not adversely affect the serum HDL/total cholesterol ratio. J Hum Hypertens 1995;9(12):975-979. [MEDLINE: 96362947]
    • Gillum 1983 {published data only} ∗ Gillum RF, Prineas RJ, Jeffery RW, Jacobs DR, Elmer PJ, Gomez O, Blackburn H. Nonpharmacologic therapy of hypertension: the independent effects of weight reduction and sodium restriction in overweight borderline hypertensive patients. Am Heart J 1983;105(1):128-133. [MEDLINE: 83097284]
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    • Velloso 1991 {published data only} ∗ Velloso LG, Alonso RR, Ciscato CM, Barretto AC, Bellotti G, Pileggi F. [Diet with usual quantity of salt in hospital treatment of congestive heart insufficiency]. Arq Bras Cardiol 1991;57(6):465-468. [MEDLINE: 92398510]
    • Watt 1983 {published data only} Watt GC, Edwards C, Hart JT, Hart M, Walton P, Foy CJ. Dietary sodium restriction for mild hypertension in general practice. British Medical Journal Clinical Research.Ed 1983; 286(6363):432-436. [MEDLINE: 83102255]
    • Watt 1986 {published data only} ∗ Watt GC, Foy CJ, Hart JT. Dietary sodium and blood pressure in young people with and without familial predisposition to high blood pressure. J Clin Hypertens 1986;2(2):141-147. [MEDLINE: 87010734]
    • Weinberger 1988 {published data only} ∗ Weinberger MH, Cohen SJ, Miller JZ, Luft FC, Grim CE, Fineberg NS. Dietary sodium restriction as adjunctive treatment of hypertension. JAMA 1988;259 (17):2561-2565. [MEDLINE: 88188298]
    • 5 (causes of death: 1 arthri- 4 (causes of death: 1 cere- During first 2 years of During the first 2 years
    • tis, 1 congestive cardiac brovascular accident bron- study 3 were treated for of study 2 were treated
    • failure, 1 cerebrovascu- chospasm, 1 myocardial congestive cardiac failure for congestive cardiac fail-
    • lar accident, 1 pulmonary infarction, 1 congestive and 0 died of CV causes, 2 ure and 1 person died (of
    • oedema and 1 unknown) cardiac failure, 1 cardiores- died from CV causes dur- CVA bronchiospasm), 3 piratory failure) ing the next 3 years died from CV causes during the next 3 years
  • Inferred research data

    The results below are discovered through our pilot algorithms. Let us know how we are doing!

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