Association patterns of urinary sodium, potassium, and their ratio with blood pressure across various levels of salt-diet regions in China

Lu Yin,Xu Liu,Nan Gao,Xinhua Zhang,Xiaoyun Liu,Wei Li,Guijuan Deng,Andrew Mente,Jian Bo,Xingyu Wang,Yang Wang,Hui Chen,Sumathy Rangarajan,Xiulin Bai,Yi Sun

doi:10.1038/s41598-018-25097-1

Abstract

We aim to evaluate the association of systolic and diastolic blood pressure (SBP and DBP) with estimated urinary sodium (Na) and potassium(K) excretions, and their gram-to-gram Na/K ratio across various salt-diet regions during 2005–2009 in China. A prospective cohort study was conducted to recruit 46,285 participants in China. A single fasting morning urine specimen was collected to estimate 24-hour urinary Na and K excretion using Kawasaki formula. Means of estimated Na and K were 5.7 ± 1.7 and 2.1 ± 0.5 grams/day, respectively, and mean estimated Na/K ratio was 2.8 ± 0.8. Adjusted analyses showed 1.70 mmHg SBP and 0.49 mmHg DBP increase per 1-g increment of estimated Na, while 1.10 mmHg SBP and 0.91 mmHg DBP decrease for one-gram increase of K. A significant increase in SBP (4.33 mmHg) and DBP (1.54 mmHg) per 1 unit increase in Na/K ratio was observed. More changes of SBP (4.39 mmHg) and DBP (1.67 mmHg) per one-unit increase of Na/K ratio were observed in low-salt regions, though significant changes were also found in moderate- and heavy-salt regions (P for heterogeneity < 0.01). Conclusively, decreasing sodium combined with increasing potassium is likely to have a more beneficial effect than decreasing sodium alone, even if those were living in low-salt regions.

Highlights

We aim to evaluate the association of systolic and diastolic blood pressure (SBP and DBP) with estimated urinary sodium (Na) and potassium(K) excretions, and their gram-to-gram Na/K ratio across various salt-diet regions during 2005–2009 in China
A positive association between sodium intake and blood pressure was shown in different populations and regions of the world[13,14,15], including our ProspectiveUrban and Rural Epidemiology (PURE) study, a large, international, prospective cohort study[16]
A number of studies found that certain subpopulations such as older individuals, people with obesity, and hypertensive individuals show greater BP increases in response to higher sodium intake[15,16,17,18]

Summary

Introduction

We aim to evaluate the association of systolic and diastolic blood pressure (SBP and DBP) with estimated urinary sodium (Na) and potassium(K) excretions, and their gram-to-gram Na/K ratio across various salt-diet regions during 2005–2009 in China. In the PURE study, in which China representedalmost half of cohort (42%), mean sodium excretion was markedly higher than countries from other parts of the world (5.6 vs 4.5 grams per day)[16]. Our primary aim was to evaluate the association patterns of 24-hour estimated sodium and potassium excretion using spot urine sample, and their gram-to-gram ratio (sodium vs potassium) with blood pressure in overall PURE-China study and in different salt classified regions from National Dietary Survey in 200223

Objectives

Methods

Results