Sodium Intake and Blood Pressure: New Controversies, New Labels . . . New Guidelines?

Abstract

H YPERTENSION AND PREHYPERTENSION ARE highly prevalent; these conditions are present in 29% and 36% of US adults aged 18 and older, respectively. Among adults aged 60 years and older, hypertension prevalence rises to about two-thirds of US adults (ie, 65%). Of individuals with hypertension, only about half (ie, 52%) have their blood pressure adequately controlled to 4,945 mg/day). The authors reported a U-shaped relation, meaning that the lowest risk of mortality and cardiovascular events was associated with the usual sodium intake level, which is above the US recommended intake of 2,300 mg/day. The American Heart Association issued a response, stating “Reduced salt intake critical,” and called the review by Graudal and colleagues flawed, in that study populations were not representative of the general population, but rather those with poor health, and that unreliable measurements of sodium intake (eg, self-reported dietary intake, spot urine secretions) were used. Within weeks, He and colleagues published results from the Health Survey for England, which attributed significant reductions in blood pressure, stroke, and ischemic heart disease mortality during an 8-year period to a 15% reduction in salt intake during this time period. Salt intake was assessed using an objective indicator (ie, biomarker) of sodium intake, 24-hour urinary sodium excretion, which was verified for completeness using para-aminobenzoic acid. Despite this strength, a limitation of