Optimal Dietary Strategies for Reducing Incident Hypertension

Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology, and Clinical Research, and Center for Human Nutrition, Baltimore, Md.
Hypertension (Impact Factor: 6.48). 09/2009; 54(4):698-9. DOI: 10.1161/HYPERTENSIONAHA.109.136630
Source: PubMed
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    ABSTRACT: Several epidemiologic studies suggested that higher sodium and lower potassium intakes were associated with increased risk of cardiovascular diseases (CVD). Few studies have examined joint effects of dietary sodium and potassium intake on risk of mortality. To investigate estimated usual intakes of sodium and potassium as well as their ratio in relation to risk of all-cause and CVD mortality, the Third National Health and Nutrition Examination Survey Linked Mortality File (1988-2006), a prospective cohort study of a nationally representative sample of 12,267 US adults, studied all-cause, cardiovascular, and ischemic heart (IHD) diseases mortality. During a mean follow-up period of 14.8 years, we documented a total of 2270 deaths, including 825 CVD deaths and 443 IHD deaths. After multivariable adjustment, higher sodium intake was associated with increased all-cause mortality (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.03-1.41 per 1000 mg/d), whereas higher potassium intake was associated with lower mortality risk (HR, 0.80; 95% CI, 0.67-0.94 per 1000 mg/d). For sodium-potassium ratio, the adjusted HRs comparing the highest quartile with the lowest quartile were HR, 1.46 (95% CI, 1.27-1.67) for all-cause mortality; HR, 1.46 (95% CI, 1.11-1.92) for CVD mortality; and HR, 2.15 (95% CI, 1.48-3.12) for IHD mortality. These findings did not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity. Our findings suggest that a higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality, and higher sodium intake is associated with increased total mortality in the general US population.
    Full-text · Article · Jul 2011 · Archives of internal medicine
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    ABSTRACT: Blood pressure naturally rises with increasing age. The rate of change in blood pressure with age is regulated in part by genetic factors, but can also be altered through sustained dietary modification. Dietary approaches to modify blood pressure remain an important part of cardiovascular health promotion, which is especially important given the aging of the general population coupled with the increasing prevalence of obesity and metabolic disturbances. Specific modification of dietary components such as macronutrients and micronutrients could be helpful to lower blood pressure and alter the slope of blood pressure change whereas nutritional supplements are less likely to have a substantial beneficial effect. Population-wide generalizations regarding diet are impractical as individualized strategies are more likely to be successful in facilitating long-term benefits in improving blood-pressure control. Consequently, more effort needs to be focused on evaluating data from large-scale observational and interventional studies and interpreting their information in a clinically relevant manner, which is likely to be helpful for individual patients. Providing education on the relationship between diet and blood pressure from an early age is most likely to produce tangible benefits.
    Full-text · Article · May 2012 · Nature Reviews Nephrology
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    ABSTRACT: Background To investigated the influence of dietary potassium on the sodium effect on BP in the general population and the adherence of current recommendations for sodium and potassium intake. Methods An overnight (12 h) urine sample was collected in a population-based study to investigate cardiovascular risk. A sub-sample of 1,285 subjects (25-64 years) free from any medication interfering with BP or potassium excretion was studied. Results 86.0% of participants consumed over 6 g of salt/day and 87.7% less than the recommended intake of potassium (4.7 g). Potassium excretion and the sodium to potassium ratio were significantly related to systolic and diastolic BP only in subjects consuming more than 6 g/day of salt. Subjects in the highest sodium to potassium ratio quartile (surrogate of unhealthy diet) presented 8 mmHg and 7 mmHg higher values of systolic and diastolic BP, respectively, when compared with the first quartile whilst individuals in the fourth quartile of urinary potassium excretion (healthier diet) showed 6 mmHg and 4 mmHg lower systolic and diastolic BP, respectively, compared with the first quartile. Conclusion Our data indicate that when people have an increased intake of potassium, high intake of sodium is not associated with higher BP.
    No preview · Article · Apr 2014 · Journal of the American Society of Hypertension (JASH)