Dietary Salt Intake Research Articles

PS-C35-9: THE EFFECT OF CEREAL MEAL (FRUGURAÂ) ON BLOOD PRESSURE

Background: Although Japanese guideline recommends to reduce salt intake to less than 6 g per day for patients with hypertension, dietary salt intake is still high, being around 10–11 g. Cereal food contains much less salt compared to a Japanese breakfast (4–5 g of salt in general), predicting the effect to reduce the blood pressure. Patients and Methods: Patients who have a risk for atherosclerotic disease w eligible for enrollment in this study. The participants took a 50 g package of Frugura∨ (cereal meal, contains 0.2 g of salt) with milk or yogurt as a breakfast at least 4 days per week. Blood pressure (BP), body composition data, estimate dietary salt intake, and serum blood data were compared between before and 4 weeks after taking the meal. Result: Sixteen patients (9 male and 7 female) were enrolled in this study. The mean age was 68.2 years-old. BP in the morning was reduced from 128.7 to 127.8 [mmHg] (p = 0.635) in systolic, and from 79.8 to 77.3 [mmHg] (p = 0.124) in diastolic. Furthermore, BP in the night was reduced from 123.5 to 122.6 [mmHg] (p = 0.606) in systolic, and from 75.1 to 71.8 [mmHg] (p < 0.05) in diastolic. The estimate dietary salt intake was reduced from 9.3 g to 8.6 g, although there was no significant difference (p = 0.370). There was also no significant difference in body weight (62.0 vs 62.0, p = 0.914 [kg]) and body fat ratio (30.2 vs 31.5, p = 0.330 [%]). Serum interleukin-6 significantly decreased after 4 weeks (2.1 vs 1.5, p < 0.05 [pg/dL]). In note, there was no significant difference in liver, kidney, and diabetes marker (HbA1c) between groups. Moreover, 13 patients out of 16 claimed improvement of bowel movement. Conclusion: There could be a potential in Frugura∨ reducing blood pressure via low salt contents.

PS-P09-6: KNOWLEDGE, ATTITUDES AND PRACTICE OF SALT INTAKE AND BLOOD PRESSURE LEVEL IN A MULTI-ETHNIC POPULATION IN MALAYSIA

Knowledge, attitudes and practice of salt intake and blood pressure level in a multi-ethnic population in Malaysia Objective: A changing lifestyle in the transition from a developing to a more developed country has led to increases in obesity, physical inactivity and unhealthy diet, including high salt intake. Studies have shown that salt consumption is high in Asia, but little is known about the practice among different ethnic groups. This study aimed to examine the knowledge, attitudes and practice of salt intake among Malaysian adults by different ethnic groups. Design and method: Participants aged = > 18 years were recruited during a blood pressure health screening campaign from various centres. All participants completed a questionnaire that capturing information on socio-demographics, knowledge, attitudes and practice about salt consumption. Weight and height were measured and seated blood pressure (BP) measurements using an oscillometric sphygmomanometer were taken twice and averaged. Hypertension is defined as a systolic BP = > 140mmHg and/or diastolic BP = > 90 mmHg. Results: A total of 5128 participants were included in the study. The mean age of the participants was 39.5 ± 17.4 years and 59.6% were female. The mean SBP was 121.4 ± 17.6 mmHg and mean DBP 75.5 ± 11.1 mmHg. 61.5% knew the correct amount (< = 5 g) of daily dietary salt intake and 8.4% did not think it was important to reduce salt intake. 68.6% took measures to control salt intake; 69.9% avoided/minimized canned food, only 34.2% look at the salt labels and less than a third do not add salt during cooking, used spices during cooking and avoid eating in outlets and all of these practices were statistically significant between ethnic groups (p < 0 .001). Knowledge, attitude and practice of not reducing high intake of dietary salt does contribute to raise high BP as shown in Table 1. Conclusion: Our study reported that good knowledge does not translate into the desired attitude or practice of lower salt intake. More needs to be done to improve attitudes and behaviours about dietary salt intake, and to tailor it to different ethnic groups. This is warranted to prevent the increasing prevalence of hypertension.

S-54-5: CHANGES IN ESTIMATED SALT AND POTASSIUM INTAKE AND SODIUM-TO-POTASSIUM RATIO USING SPOT URINE MEASUREMENTS: A 10-YEAR FOLLOW-UP OF NIPPON DATA2010

Background: Reducing dietary salt (sodium) intake and increasing potassium intake and sodium to potassium ratio (Na/K) are crucial in preventing hypertension. However, these changes by aging have not yet been evaluated in Japanese general population. Methods: NIPPON DATA2010 is a cohort study in the participants of the National Health and Nutrition Survey of Japan in 2010, we assessed changes in dietary sodium and potassium intake from 2010 to 2020 using spot urine. Of 2,732 participants in the 2010 survey, 667 participants (mean age 54.8 ± 8.2 years, women 59.1%) underwent spot urine measurements in both 2010 and 2020 survey. Using Tanaka formula, we estimated 24-hour salt intake (g/day) and potassium excretion (mg/day), and calculated sodium to potassium (Na/K) ratio (mmol/mmol) in spot urine for each participant. We assessed these changes from 2010 to 2020 by sex and age groups. Results: Change in estimated 24-hour salt intake from 2010 to 2020 was not a statistically significant in all groups (see table). Only estimated 24-hour potassium excretion showed a statistically significant increase in women and men ≧60 years, and the change showed a tendency towards statistical significance in men < 60 years. Na/K ratio was significantly reduced in women and men ≧60 years, not in men < 60 years. Conclusions: Potassium intake increased and dietary Na/K ratio decreased by 10-year aging in Japanese men and women, except for relatively younger men.

Excessive Dietary Salt Intake Exacerbates Cognitive Impairment Progression and Increases Dementia Risk in Older Adults.

To investigate excessive dietary salt intake as an independent risk factor of cognitive impairment and dementia in older adults. Prospective, population-based cohort study. Two thousand forty-one community residents aged ≥60years were recruited between April 2007 and August 2009 from the Shandong area of China. Participants were classified into low, mild, moderate, and high salt intake groups according to urinary sodium measurements for 7 consecutive days. Global cognitive function was assessed at baseline and biennially thereafter using the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Dementia Rating Scale (DRS), and Informant Questionnaire on Cognitive Decline in the Elderly. Demographics and apolipoprotein E (APOE) genotype were also obtained for each participant. Participants were monitored for 11.4 ± 2.0years. During follow-up, MMSE, MoCA, and DRS scores decreased progressively faster with increasing salt intake (Padjustment < 0.05 among all intake groups). In total, 319 participants (13.74 per 1000 person-years) developed cognitive impairment. Compared with the low salt intake group, cognitive impairment risk was increased by 75% in the mild group (Padjustment= 0.027), 180% in the moderate group (Padjustment < 0.001), and 330% in the high group (Padjustment < 0.001) after adjustment for age, education, mean, and variability in visit-to-visit systolic and diastolic blood pressure, and APOE genotype. The hazard ratio for cognitive impairment increased by 1.59 (95% CI 1.40-1.79) with each 1-SD increment in salt intake after confounder adjustment (Padjustment < 0.001). Excessive dietary salt impairs cognitive function and increases cognitive impairment risk in older adults independently of known risk factors, including hypertension and APOE genotype.

S-50-5: SALT SENSITIVITY AS MARKER FOR HYPERTENSION MANAGEMENT

Arterial hypertension is one of the most critical risk factors for cardiovascular (CV) disease, stroke, and chronic kidney disease (CKD). According to the current guidelines on hypertension management, the identification of one or more CV risk factors requires an earlier and more intensive treatment paradigm. Salt sensitivity (SSy), defined as susceptibility to changes in blood pressure related to dietary salt intake, is a well-known independent risk factor for CV disease in both the general and hypertensive population, even though it is not included in current guidelines. Is has been reported that SSy affects 30_50% of hypertensive and 25% of normotensive subjects. Salt sensitivity is more common in the elderly, women, African Americans, and patients with CKD and insulin resistance. The diagnosis of SSy is complex and not entirely standardized. The two main methods for SSy assessment are the dietary protocol versus the acute salt load. The dietary protocols typically evaluate the blood pressure variation between short periods of low and high sodium diet and often differ in both the duration and the amount of salt intake. Acute test (which consists of an i.v. infusion of 2 L of physiological solution over 2 hours) evaluates mean blood pressure (MBP) variation between the end and the start of the infusion. Three different blood pressure responses are possible: no substantial variation [salt resistant (SR) subjects], an increase in blood pressure [salt sensitive (SS) subjects], or a paradoxical decrease in blood pressure [reverse salt sensitive (RSS) subjects]. Although RSS subjects have been recognized as a third distinct group since the early 1990 s, many studies included them in the group of SR subjects. Recently, the concept of reverse salt sensitivity has been re-evaluated in relation to CV risk. Previous studies have shown an increased risk of developing cardiovascular events, hypertensive heart disease and microalbuminuria among SS patients. In our recent paper, the SS and RSS condition appear to be equivalent risk factors for CV events in hypertensives. Finally, a J curve relationship between dietary salt and cardiovascular damage has been proposed. Different pathophysiological mechanisms can be involved in SSy: renal autoregulation (Pressure natriuresis curve), Renin angiotensin aldosterone system, sympathetic nervous system activity, Insulin resistance, peripheral vascular resistances, sodium storage skin, genetic predisposition. Classification according to salt sensitivity can help in personalization of salt intake indication, intensity of therapy and timing of follow up.

PL-4: INSIGHTS INTO MOLECULAR MECHANISMS OF HYPERTENSION FROM HUMAN GENETICS

Identification and investigation of rare patients with extreme forms of high and low blood pressure has led to the identification of specific genes whose mutation results in these outlier phenotypes. These rare mutations converge on genes that mediate or regulate the renal reabsorption of Na-Cl. Mutations that increase or decrease renal salt reabsorption respectively increase or decrease blood pressure. Mutations that cause hypertension include gain of function mutations in subunits of the epithelial Na+ channel (ENaC) and in any of eight genes that cause constitutive activity of ENaC by its stimulation via its major regulator, the mineralocorticoid receptor, the target of aldosterone signaling; these increase salt reabsorption in the distal nephron. Conversely, mutations that cause hypotension include loss of function mutations in ENaC subunits, but also mutations the thiazide-sensitive Na-Cl cotransporter (NCC) or a K+ channel required for cotransporter function that act in the distal convoluted tubule (DCT), or mutations in the Na-K-2Cl cotransporter as well as K+ and Cl- channels expressed in the thick ascending limb of Henle that are required for normal Na-Cl reabsorption in this nephron segment. ENaC, the Na-Cl cotransporter and the Na-K-2Cl cotransporter, as well as the mineralocorticoid receptor are all commonly used targets for treatment of hypertension and/or diuresis. In addition to these genes, genetic studies also identified a previously unrecognized pathway that regulates the balance between renal salt reabsorption and K+ secretion. Mutations in the kinases WNK1 or WNK4, or genes that mediate their degradation via ubiquitylation, CUL3 and KLHL3 cause hypertension with hyperkalemia. Activity of WNK1 and WNK4 stimulates activation of NCC promoting Na-Cl reabsorption in the DCT, reducing Na-Cl- delivery distally, thereby limiting ENaC activity and limiting K+ secretion in the distal nephron. Conversely, hyperkalemia inhibits WNK activity, promoting distal Na-Cl delivery and maximizing K+ secretion. Angiotensin II signaling promotes WNK activity, increasing Na-Cl reabsorption in the DCT and inhibiting K+ secretion, while hyperkalemia appears to inhibit WNK activity, providing distal Na+ delivery that is used to drive K+ secretion. The importance of this pathway is that it can explain the mechanism by which increased dietary K+ lowers blood pressure. Both reduced dietary salt intake and increased dietary K+ can reduce blood pressure in controlled settings, and recent large population studies have shown that increased dietary K+ and reduced Na-Cl intake not only lower blood pressure but reduce the incidence of cardiovascular disease and death.

S-20-4: HYPERTENSION AND CARDIOVASCULAR DISEASE IN ASIA

Being the most populous continent in the world, consisting of around 60% of the global population, Asia shoulders a big brunt of the hypertension and cardiovascular disease (CVD) burden in the world. Just as it is in the rest of world, hypertension remains a major modifiable risk factor in Asia for stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral arterial disease; and it is a dominant risk factor implicated for cardiovascular deaths causing premature death in the region. There is generally a stronger association between elevated blood pressure (BP) and stroke than with coronary artery disease (CAD), although CAD is reported as the most dominant cause of CVD deaths in Central, Western, and Southern Asia, while stroke deaths is more common than CAD deaths in Eastern and Southeastern Asia. Of the estimated 1.13 billion people worldwide with elevated BP, around 66% live in low and middle income countries, which consist the majority of countries in Asia. In Southeast Asia (SEA), the prevalence of hypertension in the adult population is nearing 35%, and to this has been attributed the close to 1.5 million deaths in the region annually. Hypertension awareness, treatment and control remain a challenge in Asia. Awareness level is less than 50% in most countries in Asia, though it is higher (56 70%) in the higher income countries in the region. Treatment rates are generally 25% to 30% of the hypertensive population, but control rates to BP levels below 140/90 mmHg, are still dismally low. The comparatively high dietary salt intake in the region, aggravating the salt sensitive phenotype characterizing Asian hypertension is implicated as a significant risk factor leading to poor hypertension control and a relatively increased rates of strokes in the region. Salt intake ranges from 10to17 grams a day, which is 2to3 times higher compared to the 5 grams (approximately 2 grams of sodium) recommended daily salt consumption by the World Health Organization. Because of the socioeconomic, educational and cultural heterogeneity of the countries comprising Asia, the region appears to be in different transition stages of the CVD epidemic. This highlights the challenge in mapping out a one size fits all strategy in curbing hypertension and CVD in Asia. Individualized prevention and treatment strategies factoring the differing capacities for management, prevalence of unhealthy diet especially increased salt intake, smoking, obesity, hypertension, dyslipidemia, and diabetes, as well as the impact of population aging must be considered.

PS-C35-2: BASELINE KNOWLEDGE AND SOCIODEMOGRAPHIC FACTORS RELATED TO SALT-INTAKE BEHAVIOR AMONG HYPERTENSIVE INDIVIDUALS IN BANGLADESH: SUB-STUDY OF A RANDOMIZED CONTROLLED TRIAL

Excess salt consumption increases blood pressure which is a leading risk for developing cardiovascular diseases. Therefore, this sub-study was designed among the rural hypertensive individuals to assess the baseline knowledge about hypertension, dietary salt intake behavior and identify the potential predictors for urinary salt excretion in Bangladesh. A total of 420 participants were enrolled after meeting the eligibility criteria during the 12 months of the study period. The participants received behavior changes related to short message services (SMS) and face-to-face education from community health workers. Our study results found that most of the participants (80%) had positive knowledge of HTN. This study showed that the mean value of overnight urinary sodium excretion was 10.65 ± 3.00 at 1st-month follow-up and 10.24 ± 3.03 at the endline. We found mid-upper arm circumference (MUAC) systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly related to higher salt-intake (p = 0.009, p = 0.011 and p = 0.005 respectively). However, participants had improved their MUAC, SBP, and DBP status than their 1st follow-up period, but still, significant associations were observed between them (p = 0.033, p = 0.011, and p = 0.002 respectively). In conclusion, most of our study participants had satisfactory knowledge related to HTN and salt intake. Besides, our study results found that sodium excretion among hypertensive participants was higher, and higher urinary sodium excretion was associated with overweight and BP in adults. Nonetheless, the real salt intake practice among the Bangladeshi population is still unknown which demands further research.

S-28-6: URINARY METABOLOMICS, DIETARY SALT INTAKE AND BLOOD PRESSURE: THE AFRICAN-PREDICT STUDY

Objective: Excessive salt intake is the leading dietary risk factor for cardiovascular disease (CVD). This increased risk may be attributed to alterations in the human metabolome. Salt sensitivity is associated with ethnicity, and ethnic differences in the interaction between sodium intake and the metabolome may play an integral part in CVD development. We therefore investigated 1) the urinary metabolomic profiles of Black and White adults according to low, moderate and high dietary salt intake; and 2) explored the relationships of identified metabolites with blood pressure. Design and Methods: This study included data of White (N = 447) and Black (N = 380) adults aged 20 to 30 years from the African-PREDICT study. Estimated salt intake was determined from 24hr urinary sodium. Urinary amino acids and acylcarnitines were measured using liquid chromatography tandem mass spectrometry. Clinic, 24hr and central systolic blood pressure (SBP) were measured. Results: Whites with a high salt intake (&gt; 10 g/day) had higher SBP (clinic, 24hr and central) compared to those with low (&lt; 5 g/day) or moderate (5 to 10 g/day) salt intakes (all p &lt; 0.05). The metabolites GABA (q = 0.020), citrulline (q = 0.020), glutamic acid (q = 0.046), serine (q = 0.054) and proline (q = 0.054) were lower in those with higher salt intake. In stepwise multivariable adjusted regression analyses, we found that clinic SBP of white adults were inversely associated with GABA (Adj. R2 = 0.35; Std. β=-0.123; p = 0.005), serine (Adj. R2 = 0.35; Std. β=-0.099; p = 0.022) and proline (Adj. R2 = 0.35; Std. β=-0.099; p = 0.021), and central SBP with GABA (Adj. R2 = 0.34; Std. β=-0.094; p = 0.036), glutamic acid (Adj. R2 = 0.34; Std. β=-0.090; p = 0.035) and proline (Adj. R2 = 0.034; Std. β=-0.106; p = 0.015). In Black adults, there were no differences in SBP or metabolites between low, moderate or high salt intake groups, with no relationships between SBP and GABA, glutamic acid, citrulline, serine or proline. Conclusion: In White adults, high salt intake was associated with low levels of GABA, glutamic acid, serine and proline, which in turn were related to high SBP. We hypothesise that metabolomic changes are related to salt intake and may contribute to pathophysiological mechanisms associated with increased blood pressure.

PS-BPC08-10: IMPORTANCE OF DIETARY SALT RESTRICTION IN PRIMARY ALDOSTERONISM DURING TREATMENT WITH MINERALOCORTICOID RECEPTOR ANTAGONISTS: ROLE OF POSTTREATMENT PLASMA RENIN LEVELS

Objective: The purpose of this study is to measure the estimated dietary salt intake (eU-NaCl) when primary aldosteronism (PA) is treated with mineralocorticoid receptor antagonists (MRAs) and to evaluate whether it is important to reduce salt intake even while on MRA medications. Design and method: The eU-NaCl values were investigated in 26 PA patients who were treated with MRAs at pre-treatment and 6-month treatment. The eU-NaCl was calculated as follows: eU-NaCl (g/day) = 21.98 * {urinary sodium (mmol / L) / &lt;urinary creatinine (mg / dL) * 10&gt; * (Body Weight (kg) × 14.89 + Height (cm) × 16.14 - age × 2.043 - 2244.45)}. Results: Data are shown as median {first quartile - third quartile}. Various clinical parameters of 26 PA patients were compared between pre-treatment and 6 months MRA treatment; Systolic blood pressure (138 mmHg {124.5–157.7} vs 125 mmHg {117.8–130.8}, p &lt; 0.01) and diastolic blood pressure (86 mmHg {80.5–95.0} vs 78 mmHg {74.5–86.3}, p = 0.02) were decreased, serum potassium (3.9 mmol/L {3.8–4.3} vs 4.3 mmol/L {4.0–4.6}, p &lt; 0.01) and active renin concentration (ARC) (2.6 pg/mL {1.2–3.8} vs 6.1 pg/mL {3.5–10.3}, p &lt; 0.01) were increased significantly. The eU-NaCl (8.9 g/day {8.0–10.2} vs. 10.0 g/day {7.8–12.0}, p = 0.27) did not change. The correlation between the difference in eU-NaCl (ΔeU-NaCl) and the difference in ARC (ΔARC) before and after MRA treatment showed a significant inverse correlation (r = -0.418, p = 0.03). Furthermore, when the 26 patients were divided into 2 groups of ARC &gt;5 pg/mL and ARC &lt; 5 pg/mL after MRA treatment, ΔeU-NaCl and ΔARC showed no significant correlation in 16 patients with ARC ≧ 5 pg/mL (r = -0.481, p = 0.11), whereas a strong inverse correlation in 10 patients with ARC &lt; 5 pg/mL (r = -0.7599, p = 0.01). Conclusions: The present data indicate that post-MRA treatment ARC of less than 5pg/mL reflects insufficient improvement of salt sensitivity, suggesting the importance of dietary salt restriction even in the presence of MRA treatment.

Effects of dietary salt intake restriction on blood glucose levels: a meta-analysis of crossover study.

To identify modifiable risk factors for type 2 diabetes mellitus and explore the relationship between diet sodium intake and blood glucose levels. Based on inclusion and exclusion criteria, we extracted, analyzed, and assessed the available crossover studies of dietary salt intake restriction and insulin resistance in PubMed, Web of Science, MEDLINE, Embase, Wanfang, and CNKI databases. We included 6 studies with 8 sets of data, covering 485 subjects. I2 statistics results showed insignificant heterogeneity among all data (I2 = 39.2% < 50%). Thus, a fixed-effect model was adopted for the final pooled effect size. Weighted mean difference and its 95% confidence interval (CI) value was 0.193 (95% CI, 0.129-0.257), and the test of the overall effect showed P < 0.001. The results revealed that the blood glucose levels in the subjects in the low-salt intake group were significantly higher than those in the normal or high-salt intake groups. We also found no significant change occurred after the removal of any study through sensitivity analysis, which confirmed that the outcome we calculated was prudent and credible. The quantitative Egger's test (P = 0.109 > 0.05) indicated that insignificant publication bias existed. This meta-analysis highlights the relationship between dietary sodium intake and blood glucose levels. Our findings show that higher blood glucose levels might be expected in hypertensive or normal people with low-salt consumption compared to those with normal or high-salt consumption, although these differences were not clinically significant. PROSPERO Identifier: CRD42021256998.

PS-C35-8: ESTIMATING A MODEL FOR 24-HOUR URINARY SODIUM EXCRETION FROM SPOT URINE SODIUM AND CREATININE OF BANGLADESHI POPULATION

Background: The best estimate of population distribution and the average level of dietary salt intake is provided by measuring 24hour urinary sodium (Na) excretion in a representative sample. Collection of 24hour urine is difficult for community living people, and therefore, use of the spot urine Na concentration for estimation of daily salt intake was proposed as an alternative to 24hour urine collection. Purpose: To develop and validate equations to estimate the population mean levels of 24hour urinary Na excretion from spot urine Na for a Bangladeshi population. Methods: We utilized a dataset in which estimates of urinary Na levels were available from urine samples from 24hour urine collection and from spot urine of 217 participants, aged 40 to 59 years. We developed formulas to estimate 24hour urinary Na (24HUNa) by using 24hour urinary Creatinine (24HUCr), spot urine Na (SUNa), and spot urine creatinine (SUCr). For the reliability and validity tests of developed formulas, we use another dataset of 517 participants, aged 30 to 59 years, that also contains Na levels from urine samples from 24hour urine collection and from spot urine collection. Results: The obtained formulas were as follows: (i) PRCr (mg/day) = − 6.68 × age (year) + 14.68 × weight (kg) + 23.89 × height (cm) − 3198.18; (ii) estimated 24HUNa (mmol/day) = 42.40 × XNa0.270; where PRCr = predicted value of 24HUCr, XNa = SUNa (mmol/L)/SUCr (mg/L) × PRCr (mg/day). The correlation coefficients of Na (mmol/day) between estimated and measured from 24hour urine sample were 0.477, which was statistically highly significant (p &lt; 0.001). The mean difference (bias) between estimated and measured Na (mmol/day) was 2.9, which was not statistically significant (p &gt; 0.05). Intraclass correlation coefficient (ICC) between estimated and measured 24HUNa was 0.502. Conclusions: These formulas are useful for estimating population mean levels of 24hour urinary Na excretion, though this method is not suitable for estimating individual Na excretion.

Fumarate hydratase as a potential target to ameliorate salt sensitive hypertension

Salt sensitive hypertension is a major risk factor for stroke, heart failure, and end-stage renal disease. The development of salt sensitive hypertension is involved in genetic and environmental factors. Excessive dietary salt intake is known as a main risk factor and one of the most important environmental determinants, exacerbates the salt sensitive hypertension by a renal redox metabolism.

RECOMENDAÇÃO DE DIETAS HIPOSSÓDICAS EM PACIENTES PORTADORES DE INSUFICIÊNCIACARDÍACA CONGESTIVA

Introduction: Heart failure (HF) is a chronic disease with a high hospital cost, and of a complex and systemic nature. A growing public health problem, HF can cause several limitations in the lives of patients and lead to a reduction in quality of life, consisting of a major concern of health programs. Studies show that patients lack of knowledge regarding pharmacological, and non-pharmacological treatment and poor therapeutic adherence are factors that are involved in HF decompensation and rehospitalizations. Although salt restriction plays a fundamental role in the pathophysiology of HF, this is still a highly discussed topic in the treatment of these patients. Objective: In order to broaden the view of the nutritionist’s role in the treatment of patients with HF in relation to sodium restriction in the diet, the present study reviewed the literature in search of evidence on the recommendation of a low-sodium diet in the treatment of these patients. Methodology: A systematic literature review was carried out in the Medline, Pubmed, Lilacs, SciELO and national and international health committees’ databases, of articles published from 2005 to 2022. Conclusion: Salt intake for patients with HF should be individualized, as the response to dietary salt intake may vary among different individuals. Therefore, other studies, including randomized clinical trials, are needed to analyze the restriction of salt intake for prolonged periods.

The impact of low-salt bread as a simple diet on hypertensive patients with cardiovascular comorbidities.

During recent years, hypertension and related cardiovascular complications have become the leading health challenges of this century. Non-pharmacologic strategies, emphasizing mainly salt restriction and physical activity, are recommended for all patients with hypertension. Our objective was to assess the impact of low salt white bread intake, widely consumed in Western Algeria, on blood pressure values in hypertensive patients with and without comorbidities. 134 hypertensive patients (male = 78, female = 56) were included. The study population was divided into two groups according to their choice of following a low salt white bread diet or not. Their dietary salt intake and physical activity were surveyed along with their blood pressure measurements and associated comorbidities. Other clinical and anthropometric data were collected. Patients following low salt bread diet showed decreased systolic and diastolic blood pressure values (119.07/74.63 mmHg) compared to the second group (131.92/79.81) (p < 0.01). These results were observed specifically in patients with adjacent cardiovascular diseases who seem to be less compliant to the diet (41.1% of the whole population, p < 0.05) and show significant increased blood pressure (135.75/81.53 mmHg) compared to compliant patients (116.66/75.33 mmHg) (p < 0.01). The study highlights the impact of low salt bread diet on the treatment of hypertension with and without comorbidities.

Estimation of Salt Intake and its Relation to Knowledge and Attitude Regarding the Dangers of High Salt Intake among an Urban Omani Population: A pilot study.

High salt consumption is a major risk factor for hypertension. Studies have shown dietary salt intake to be high in many parts of the world. This study aimed to assess the daily salt consumption of the Omani urban population and their knowledge and attitudes regarding dietary salt. This cross-sectional questionnaire-based study was conducted in Muscat between September and December 2017. Participants were recruited from malls, university students and staff, hospital staff and their relatives and relatives of patients. A previously validated questionnaires were used to assess the participants' salt intake and their knowledge and attitudes regarding salt intake. A total of 345 participants were included in this study (response rate: 69%), of which 300 responses (mean age: 27.88 ± 7.9 years, 54.3% male) were included for analysis. Overall, 94.3% of the participants agreed that lowering salt in diet is important, and nearly half the participants said that they were taking measures to reduce salt intake. However, the median salt intake was high at 10.5 g/day (interquartile range: 7.3-15.1 g/day), with 90% of the respondents consuming more than the maximum recommended amount of salt per day. Salt intake was significantly higher in women and the older age group (>40 years). There did not appear to be any correlation between awareness of the dangers of salt intake and the amount consumed. The salt intake in the sampled population in Oman was high and did not depend on knowledge. Strategies should be designed to reduce salt intake among the urban population, including health education to increase knowledge about the complications of high salt intake.

Assessment of Dietary Salt Intake Markers Among Hypertensives Attending Primary Care Clinic of a Nigerian Tertiary Hospital

Assessment of Dietary Salt Intake Markers Among Hypertensives Attending Primary Care Clinic of a Nigerian Tertiary Hospital

ODP270 Prevalence of Primary Hyperaldosteronism in Patients with Resistant Hypertension - An Outpatient Cross-Sectional Clinic-Based Study

Abstract Background Primary hyperaldosteronism is the non-suppressible over secretion of aldosterone caused either by an adenoma or bilateral adrenal hyperplasia. Although its reported prevalence is 8-10% in recent studies, intraindividual variability for aldosterone levels poses diagnostic challenges during the screening of these patients. In this study, we aim to assess the prevalence of primary hyperaldosteronism in patients presenting with drug-resistant hypertension, with or without hypokalemia, at a general endocrinology practice with an emphasis on the variability of renin and aldosterone levels in the screening tests used to detect primary hyperaldosteronism. Method: We included participants presenting at our outpatient clinic from June 2020 until January 2022 with blood pressure&amp;gt;140/90mm Hg despite the use of three antihypertensive medications including a diuretic. The screening tests used were morning (8-9 AM) plasma aldosterone concentration (PAC) and plasma renin (PR) level. Aldosterone was measured using L iquid Chromatography-Tandem Mass Spectrometry assay determined by Mayo Clinic. The screening was considered positive when PAC was&amp;gt;10 ng/dL (277 pmol/l) and PR was &amp;lt;1 ng/ml/hr. The tests were repeated if PAC was between 5-10 ng/dL and PR was between 1-2 ng/ml/hr without any medication changes. If the repeat PR was &amp;gt;2 ng/ml/hr, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were stopped and changed to calcium channel blockers, and the patient was tested again after 2 weeks. Positive results were further tested with 24-hour urinary aldosterone excretion during high dietary salt ingestion with 24-hour urine sodium and creatinine. Primary hyperaldosteronism was confirmed if plasma renin activity was &amp;lt;1. 0 ng/mL per hour and urinary aldosterone was &amp;gt;12 mcg/24-hour during high urinary sodium excretion (&amp;gt;200 mEq/24-hour). Results We studied a total of 138 patients during this study period. Mean age was 58.7 years and BMI 33.7 kg/m 2, out of which 95 participants had type 2 diabetes mellitus, 7 had obstructive sleep apnea, and 20 had chronic kidney disease stage 3 or higher. We found 3 patients were positive on screening tests and two patients were confirmed to have primary hyperaldosteronism, making prevalence 2/138(1.45%). Conclusion Hyperaldosteronism is the most common cause of secondary hypertension, especially resistant hypertension. Repeat testing of aldosterone levels with intraindividual variability can be very challenging, and time-consuming resulting in repeated follow-up visits and multiple communications with providers posing challenges for effective care coordination, and financial burden on patients. Further large-scale studies are recommended to re-analyze the protocols for screening hyperaldosteronism and treatment initiation without extensive confirmatorytesting. We also suggest health care providers emphasize on effective management of other secondary causes of hypertension such as obesity and Metabolic Syndrome with diabetes for a greater impact on blood pressure control on these patients. Presentation: No date and time listed

Mapping corticosteroids in mouse kidney following changes in dietary salt intake using mass spectrometry imaging

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt.

This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a “fight or flight” response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.