Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride

Recent cohort studies show that salt intake below 6 g is associated with increased mortality. These findings have not changed public recommendations to lower salt intake below 6 g, which are based on assumed blood pressure (BP) effects and no side-effects. To assess the effects of sodium reduction o...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2020-12, Vol.12 (12), p.CD004022-CD004022
Main Authors: Graudal, Niels Albert, Hubeck-Graudal, Thorbjørn, Jurgens, Gesche
Format: Article
Language:English
Subjects:
Aldosterone - blood
Asian People
Bias
Black People
Blood Pressure - drug effects
Catecholamines - blood
Cholesterol - blood
CHRONIC KIDNEY DISEASE
Complementary & alternative medicine
Confidence Intervals
Diet, Sodium-Restricted
END-STAGE KIDNEY DISEASE
Epinephrine - blood
Heart & circulation
Humans
Hypertension - diet therapy
Hypertension - ethnology
Kidney disease
Norepinephrine - blood
Prevention of Hypertension
Randomized Controlled Trials as Topic
Recommended Dietary Allowances
Renin - blood
Sodium Chloride, Dietary - pharmacology
Treatment of essential Hypertension
Triglycerides - blood
White People
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Summary:Recent cohort studies show that salt intake below 6 g is associated with increased mortality. These findings have not changed public recommendations to lower salt intake below 6 g, which are based on assumed blood pressure (BP) effects and no side-effects. To assess the effects of sodium reduction on BP, and on potential side-effects (hormones and lipids) SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to April 2018 and a top-up search in March 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. The top-up search articles are recorded under "awaiting assessment." Studies randomizing persons to low-sodium and high-sodium diets were included if they evaluated at least one of the outcome parameters (BP, renin, aldosterone, noradrenalin, adrenalin, cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride,. Two review authors independently collected data, which were analysed with Review Manager 5.3. Certainty of evidence was assessed using GRADE. Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different BP outcomes in black and white study populations, we stratified the BP outcomes by race. The effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.14 mmHg (95% confidence interval (CI): -1.65 to -0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: -0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD -5.71 mmHg (95% CI: -6.67 to -4.74), 3998 participants,88 trials; DBP: MD -2.87 mmHg (95% CI: -3.41 to -2.32), 4032 participants, 89 trials (all high-quality evidence). The largest bias contrast across studies was recorded for the detection bias element. A comparison of detection bias low-risk studies versus high/unclear risk studies showed no differences. The effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean differe
ISSN:1469-493X
DOI:10.1002/14651858.CD004022.pub5