Abstract
While sodium is essential for human homeostasis, current salt consumption far exceeds physiological needs. Strong evidence suggests a direct causal relationship between sodium intake and blood pressure (BP) and a modest reduction in salt consumption is associated with a meaningful reduction in BP in hypertensive as well as normotensive individuals. Moreover, while long-term randomized controlled trials are still lacking, it is reasonable to assume a direct relationship between sodium intake and cardiovascular outcomes. However, a consensus has yet to be reached on the effectiveness, safety and feasibility of sodium intake reduction on an individual level. Beyond indirect BP-mediated effects, detrimental consequences of high sodium intake are manifold and pathways involving vascular damage, oxidative stress, hormonal alterations, the immune system and the gut microbiome have been described. Globally, while individual response to salt intake is variable, sodium should be perceived as a cardiovascular risk factor when consumed in excess. Reduction of sodium intake on a population level thus presents a potential strategy to reduce the burden of cardiovascular disease worldwide. In this review, we provide an update on the consequences of salt intake on human health, focusing on BP and cardiovascular outcomes as well as underlying pathophysiological hypotheses.
Highlights
Sodium (Na+), contained in dietary salt, is essential for human homeostasis
We review the available evidence on the association between sodium intake, blood pressure (BP) and cardiovascular diseases
The TONE and TOHP-II trials reported similar additive effects of sodium reduction with weight reduction [11,12]. Taking into account such compensatory mechanism, a randomized controlled trial showed that sodium reduction allowed for a further reduction of BP in hypertensive individuals treated with captopril as compared to normal sodium intake [21]
Summary
Sodium (Na+), contained in dietary salt, is essential for human homeostasis. For millions of years, our ancestors ate less than 0.25 g of salt per day, while the current average daily consumption approaches 10 g in most countries [1,2]. In the TOHP-II (Trial of Hypertension Prevention) study, investigators evaluated the impact of long-term sodium intake reduction and weight loss on blood pressure in 2382 individuals not taking antihypertensive medications using a factorial design [11]. A first meta-analysis, which included 36 randomized controlled trials and 6736 adult individuals showed that reduced sodium intake was associated with a decrease in BP of 3.39/1.54 mmHg without an adverse effect on renal function, or metabolic or endocrine profile [13]. The TONE and TOHP-II trials reported similar additive effects of sodium reduction with weight reduction [11,12] Taking into account such compensatory mechanism, a randomized controlled trial showed that sodium reduction allowed for a further reduction of BP in hypertensive individuals treated with captopril as compared to normal sodium intake [21]. The few existing long-term interventional trials showed that maintaining a lower salt intake on a prolonged time period is challenging from an individual perspective given the societal food environment [11,31]
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