open access

Vol 24, No 4 (2020)
REVIEW
Published online: 2020-09-07
Get Citation

Salt and arterial hypertension — epidemiological, pathophysiological and preventive aspects

Stanisław Surma1, Anna Szyndler2, Krzysztof Narkiewicz2
·
Arterial Hypertension 2020;24(4):148-158.
Affiliations
  1. Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
  2. Chair and Department of Hypertension and Diabetology, Medical University in Gdańsk, Poland

open access

Vol 24, No 4 (2020)
REVIEW
Published online: 2020-09-07

Abstract

Arterial hypertension in majority of cases is the result of a poor lifestyle. The table salt intake level has changed over the centuries. In populations characterized by a low level of daily salt consumption, hypertension was a rarity and cardiovascular diseases were much less common. More and more food is sold in processed form, and thus containing large amounts of salt. The amount of salt delivered with food significantly exceeds the actual body’s needs. Limitation of salt intake should apply to both prevention of hypertension and cardiovascular diseases as well as treatment of people suffering from hypertension. High sodium intake leads to increased systolic and diastolic pressure, increases the risk of cardiovascular disease as well as other diseases such as stomach cancer etc. There are many mechanisms triggered by excessive intake of table salt that lead to an increase in blood pressure. Excess salt adversely affects the entire human body, and in particular the kidneys and blood vessels. National and International Scientific Societies have developed many documents in the form of guidelines on the optimal daily sodium intake. Compliance with the recommendations and limitation of salt intake may significantly reduce the incidence of hypertension in the general population.

Abstract

Arterial hypertension in majority of cases is the result of a poor lifestyle. The table salt intake level has changed over the centuries. In populations characterized by a low level of daily salt consumption, hypertension was a rarity and cardiovascular diseases were much less common. More and more food is sold in processed form, and thus containing large amounts of salt. The amount of salt delivered with food significantly exceeds the actual body’s needs. Limitation of salt intake should apply to both prevention of hypertension and cardiovascular diseases as well as treatment of people suffering from hypertension. High sodium intake leads to increased systolic and diastolic pressure, increases the risk of cardiovascular disease as well as other diseases such as stomach cancer etc. There are many mechanisms triggered by excessive intake of table salt that lead to an increase in blood pressure. Excess salt adversely affects the entire human body, and in particular the kidneys and blood vessels. National and International Scientific Societies have developed many documents in the form of guidelines on the optimal daily sodium intake. Compliance with the recommendations and limitation of salt intake may significantly reduce the incidence of hypertension in the general population.

Get Citation

Keywords

salt; arterial hypertension; cardiovascular disease

About this article
Title

Salt and arterial hypertension — epidemiological, pathophysiological and preventive aspects

Journal

Arterial Hypertension

Issue

Vol 24, No 4 (2020)

Pages

148-158

Published online

2020-09-07

Page views

1395

Article views/downloads

943

DOI

10.5603/AH.a2020.0012

Bibliographic record

Arterial Hypertension 2020;24(4):148-158.

Keywords

salt
arterial hypertension
cardiovascular disease

Authors

Stanisław Surma
Anna Szyndler
Krzysztof Narkiewicz

References (89)
  1. Kannel W. Blood Pressure as a Cardiovascular Risk Factor. JAMA. 1996; 275(20): 1571.
  2. World Health Report 2002: Reducing risks, promoting healthy life. World Health Organisation, Geneva 2002. www.who.int/whr/2002 (28 May 2010).
  3. Mendis S, Puska P, Norriving B. (eds). Global Atlas of Cardiovascular Disease Prevention and Control. WHO, Geneva 2011.
  4. Zdrojewski T, Rutkowski M, Bandosz P, et al. Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 Survey. Kardiol Pol. 2013; 71(4): 381–392.
  5. Surma S, Szyndler A, Narkiewicz K. Awareness of selected heart disease risk factors among young people. Choroby Serca i Naczyń. 2017; 14(4): 186–193.
  6. Surma S, Szyndler A, Narkiewicz K. Awareness of hypertension and other risk factors for cardiovascular disease in the adult population. Choroby Serca i Naczyń. 2018; 15(1): 14–22.
  7. Kaplan NM. Clinical hypertension. Williams&Wilkins, New York 1998.
  8. Freis E. The role of salt in hypertension. Blood Press. 2009; 1(4): 196–200.
  9. Jarosz M, Szponar L, Rychlik E, Wierzejska E. Woda i elektrolity. In: Jarosz M. ed. Normy żywienia dla populacji polskiej — nowelizacja. Instytut Żywności i Żywienia, Warszawa 2010: 143–153.
  10. Polacy a spożycie soli. Raport MNIEJ SOLI. http://www.mniejsoli.pl/Raport_Mniej_Soli.pdf.
  11. He FJ, Burnier M, Macgregor GA. Nutrition in cardiovascular disease: salt in hypertension and heart failure. Eur Heart J. 2011; 32(24): 3073–3080.
  12. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ. 1988; 297(6644): 319–328.
  13. Karppanen H, Mervaala E. Sodium intake and mortality. Lancet. 1998; 351(9114): 1509.
  14. European Society of Cardiology. www.escardio.org.
  15. National Health and Nutrition Examination Survey (NHANES), 2007–2008. ICPSR Data Holdings. 2010.
  16. Pelofske E. Healthy food can taste good. https://www.preparedfoods.com/articles/116709-formulating-healthy-foods.
  17. Adamczak M, Słabiak-Błaż N, Ritz E. Sól a nadciśnienie tętnicze. In: Więcek A, Kokot F. ed. Postępy w nefrologii i nadciśnieniu tętniczym. T 9. Medycyna Praktyczna, Kraków 2010: 11–17.
  18. Czerwińska D, Czerniawska A. Ocena spożycia sodu, z uwzględnieniem soli kuchennej jako jego źródło, w wybranej populacji warszawskiej. Rocz Panstw Zakl Hig. 2007; 58: 205–210.
  19. Lambers Heerspink HJ, Navis G, Ritz E. Salt intake in kidney disease — a missed therapeutic opportunity? Nephrol Dial Transplant. 2012; 27(9): 3435–3442.
  20. Stolarz K, Staessen JA, Kawecka-Jaszcz K, et al. European Project On Genes in Hypertension (EPOGH) Investigators. Genetic variation in CYP11B2 and AT1R influences heart rate variability conditional on sodium excretion. Hypertension. 2004; 44(2): 156–162.
  21. Nutrient Reference Values for Australia and New Zealand. Sodium. https://www.nrv.gov.au/nutrients/sodium.
  22. Bańkowski E. Biochemia — podręcznik dla studentów uczelni medycznych. Wyd. III. Edra Urban & Partner, Wrocław 2016.
  23. Sasaki N. The salt factor in apoplexy and hypertension: epidemiological studies in Japan. In: Yamori Y. ed. Prophylactic approach to hypertensive diseases. Raven Press, New York 1979: 467–474.
  24. Strazzullo P, D'Elia L, Kandala NB, et al. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009; 339(8): b4567–701.
  25. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, et al. European Project on Genes in Hypertension (EPOGH) Investigators. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011; 305(17): 1777–1785.
  26. He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension. 2003; 42(6): 1093–1099.
  27. Tunstall-Pedoe H, Woodward M, Tavendale R, et al. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study. BMJ. 1997; 315(7110): 722–729.
  28. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007; 334(7599): 885–888.
  29. Hajjar IM, Grim CE, George V, et al. Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Arch Intern Med. 2001; 161(4): 589–593.
  30. Sacks FM, Svetkey LP, Vollmer WM, et al. DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001; 344: 3–10.
  31. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens. 1992; 6(1): 23–25.
  32. Xie JX, Sasaki S, Joossens JV, et al. The relationship between urinary cations obtained from the INTERSALT study and cerebrovascular mortality. J Hum Hypertens. 1992; 6(1): 17–21.
  33. Hummel SL, DeFranco AC, Skorcz S, et al. Recommendation of low-salt diet and short-term outcomes in heart failure with preserved systolic function. Am J Med. 2009; 122(11): 1029–1036.
  34. Forte JG, Miguel JM, Miguel MJ, et al. Salt and blood pressure: a community trial. J Hum Hypertens. 1989; 3(3): 179–184.
  35. Laatikainen T, Pietinen P, Valsta L, et al. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006; 60(8): 965–970.
  36. He J, Ogden LG, Vupputuri S, et al. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA. 1999; 282(21): 2027–2034.
  37. Kojuri J, Rahimi R. Effect of "no added salt diet" on blood pressure control and 24 hour urinary sodium excretion in mild to moderate hypertension. BMC Cardiovasc Disord. 2007; 7: 34.
  38. Elliott P, Walker LL, Little MP, et al. Change in salt intake affects blood pressure of chimpanzees: implications for human populations. Circulation. 2007; 116(14): 1563–1568.
  39. Jürgens G, Graudal NA, Jürgens G, et al. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride. Cochrane Database Syst Rev. 2003(1): CD004022.
  40. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002; 16(11): 761–770.
  41. Melander O, von Wowern F, Frandsen E, et al. Moderate salt restriction effectively lowers blood pressure and degree of salt sensitivity is related to baseline concentration of renin and N-terminal atrial natriuretic peptide in plasma. J Hypertens. 2007; 25(3): 619–627.
  42. Takahashi Y, Sasaki S, Okubo S, et al. Blood pressure change in a free-living population-based dietary modification study in Japan. J Hypertens. 2006; 24(3): 451–458.
  43. Cardiovascular Disease Prevention. Public Health Guidance [PH25]. https://www.nice.org.uk/guidance/PH25.
  44. Stolarz-Skrzypek K, Kawecka-Jaszcz K. Ograniczenie spożycia soli kuchennej jako metoda prewencji nadciśnienia tętniczego. Postępy Nauk Medycznych. 2009; 1: 34–38.
  45. Meneton P, Jeunemaitre X, de Wardener HE, et al. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev. 2005; 85(2): 679–715.
  46. Serafin WE. Dietary Salt Intake and Blood Pressure. JAMA. 1984; 251(11): 1429–1430.
  47. Greenland P. Beating high blood pressure with low-sodium DASH. N Engl J Med. 2001; 344(1): 53–55.
  48. Whelton PK, Appel LJ, Espeland MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998; 279(11): 839–846.
  49. Stamler J, Elliott P, Dyer AR, et al. Commentary: Sodium and blood pressure in the Intersalt study and other studies — in reply to the Salt Institute. BMJ. 1996; 312(7041): 1285–1287.
  50. McGregor GA, Markandu ND, Sagnella GA, et al. Double-blind study of free sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989; 2(8674): 1244–1247.
  51. Li J, White J, Guo L, et al. Salt inactivates endothelial nitric oxide synthase in endothelial cells. J Nutr. 2009; 139(3): 447–451.
  52. Gu JW, Anand V, Shek EW, et al. Sodium induces hypertrophy of cultured myocardial myoblasts and vascular smooth muscle cells. Hypertension. 1998; 31(5): 1083–1087.
  53. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007; 334(7599): 885–888.
  54. Katori M, Majima M. A missing link between a high salt intake and blood pressure increase. J Pharmacol Sci. 2006; 100(5): 370–390.
  55. Stamler J. The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr. 1997; 65(2 Suppl): 626S–642S.
  56. Dahl LK. Possible role of salt intake in the development of essential hypertension. 1960. Int J Epidemiol. 2005; 34(5): 967–72; discussion 972.
  57. Cappuccio FP. Cardiovascular and other effects of salt consumption. Kidney Int Suppl (2011). 2013; 3(4): 312–315.
  58. Ferrara LA, de Simone G, Pasanisi F, et al. Left ventricular mass reduction during salt depletion in arterial hypertension. Hypertension. 1984; 6(5): 755–759.
  59. Jula AM, Kranko HM. Effect on left ventricular hypertrophy of long-term nonpharmagological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation. 1994; 89(3): 1023–1031.
  60. Kagiyama S, Koga T, Kaseda S, et al. Correlation between increased urinary sodium excretion and decreased left ventricular diastolic function in patients with type 2 diabetes mellitus. Clin Cardiol. 2009; 32(10): 569–574.
  61. Yu HC, Burrell LM, Black MJ, et al. Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats. Circulation. 1998; 98(23): 2621–2628.
  62. Tuomilehto J, Jousilahti P, Rastenyte D, et al. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet. 2001; 357(9259): 848–851.
  63. Verhave JC, Hillege HL, Burgerhof JGM, et al. PREVEND Study Group. Sodium intake affects urinary albumin excretion especially in overweight subjects. J Intern Med. 2004; 256(4): 324–330.
  64. Swift PA, Markandu ND, Sagnella GA, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Hypertension. 2005; 46(2): 308–312.
  65. Bernardi S, Toffoli B, Zennaro C, et al. High-salt diet increases glomerular ACE/ACE2 ratio leading to oxidative stress and kidney damage. Nephrol Dial Transplant. 2012; 27(5): 1793–1800.
  66. Devine A, Criddle RA, Dick IM, et al. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr. 1995; 62(4): 740–745.
  67. Burger H, Grobbee DE, Drüeke T, et al. Osteoporosis and salt intake. Nutr Metab Cardiovasc Dis. 2000; 10(1): 46–53.
  68. Li H, Han X, Hu Z, et al. Associations of NADPH oxidase-related genes with blood pressure changes and incident hypertension: The GenSalt Study. J Hum Hypertens. 2018; 32(4): 287–293.
  69. He FJ, Markandu ND, Sagnella GA, et al. Effect of salt intake on renal excretion of water in humans. Hypertension. 2001; 38(3): 317–320.
  70. D'Elia L, Rossi G, Ippolito R, et al. Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clin Nutr. 2012; 31(4): 489–498.
  71. González SA, Forcada P, de Cavanagh EMV, et al. Sodium intake is associated with parasympathetic tone and metabolic parameters in mild hypertension. Am J Hypertens. 2012; 25(5): 620–624.
  72. Głuszek J. Ograniczenie podaży soli w diecie powinno być powszechnie zalecane. 12 Katowickie Seminarium „Postępy w nefrologii i nadciśnieniu tętniczym", Katowice 2012.
  73. Szyndler A, et al. Summary of the article: Stolarz-Skrzypek K, Kuznetsova T, Thijs L Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA, 2011; 305: 1777–1785. Kardiol Pol. 2011; 69: 1314–1315.
  74. Kiowski W, Jordan J. Działania niefarmakologiczne. Nadciśnienie Tętnicze. Podręcznik European Society of Hypertension. Via Medica, Gdańsk 2009.
  75. Tikellis C, Pickering RJ, Tsorotes D, et al. Activation of the Renin-Angiotensin system mediates the effects of dietary salt intake on atherogenesis in the apolipoprotein E knockout mouse. Hypertension. 2012; 60(1): 98–105.
  76. He F, MacGregor G. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004; 4(CD004937).
  77. Alderman MH, Cohen HW, Alderman MH, et al. Dietary sodium intake and cardiovascular mortality: controversy resolved? Am J Hypertens. 2012; 25(7): 727–734.
  78. Guyton AC. Kidneys and fluids in pressure regulation. Small volume but large pressure changes. Hypertension. 1992; 19(1 Suppl): I2–I8.
  79. Kanbay M, Chen Y, Solak Y, et al. Mechanisms and consequences of salt sensitivity and dietary salt intake. Curr Opin Nephrol Hypertens. 2011; 20(1): 37–43.
  80. Iwamoto T. Na+/Ca2+ exchange as a drug target — insights from molecular pharmacology and genetic engineering. Ann NY Acad Sci. 2007; 1099: 516–528.
  81. Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell. 2001; 104(4): 545–556.
  82. Surma S, Romańczyk M, Bańkowski E. [The role of limiting sodium intake in the diet — from theory to practice]. Folia Cardiol. 2020; 15(3): 59–132.
  83. World Health Organisation (WHO). Guideline: sodium intake in adults and children. WHO, Geneva 2012.
  84. Williams B, Mancia G, Spiering W, et al. Authors/Task Force Members:, ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
  85. Tykarski A, Filipiak KJ, Januszewicz A, et al. Zasady postępowania w nadciśnieniu tętniczym — 2019 rok Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce. 2019; 5: 1–86.
  86. Szybiński Z, Jarosz M, Hubalewska-Dydejczyk A, et al. [Iodine-deficiency prophylaxis and the restriction of salt consumption — a 21st century challenge]. Endokrynol Pol. 2010; 61 Suppl 1(1): 1–6.
  87. Szybiński Z, Brzośka F, Śliwiński B. Iodine concentration in ish milk — variations due to season and region. Pol J Endocrinol. 2009; 60: 449–454.
  88. Ziemlański Ś, Zawistowska Z. Kuchnia dietetyczna z solą czy bez soli. Warta, Warszawa 1991.
  89. Chang HY, Hu YW, Yue CSJ, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr. 2006; 83(6): 1289–1296.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl