What is the clinical evidence from this study?

Study design: Review. Population: Hypertension. Intervention: Dietary sodium restriction.

November 2, 2023

Salt restriction for treatment of hypertension – current state and future directions

Key Result

Dietary sodium restriction to 2-3 g/day in the general population and 2 g/day in hypertensive patients is reasonable, though the feasibility and safety of targets <1.5 g/day remain uncertain.

Structured PICO

Does dietary sodium restriction improve cardiovascular outcomes in the general population and patients with hypertension?

Population

General population and persons with hypertension or cardiovascular disease

Intervention

Dietary sodium restriction (target 2-3 g/day or as low as 2 g/day)

A target sodium intake of 2-3 g/day is recommended for the general population and hypertensive patients, while the benefits and safety of stricter targets (<1.5 g/day) remain debated.

Limitations

Feasibility of achieving and maintaining dietary sodium <1.5 g/day in real-world settings is uncertain
Potential harm of very low sodium intake (<1.5 g/day) remains an open question

Abstract

PURPOSE OF REVIEW: Given the adverse effects of excess dietary sodium chloride (also known as table salt) on blood pressure (BP) and cardiovascular disease (CVD), restriction of dietary sodium is recommended by numerous guidelines. The strictest of these recommend no more than 1.5 g/day of dietary sodium among hypertensive persons. However, average dietary sodium intake in the population is closer to 5 g/day and there is debate about whether too much sodium restriction may be associated with increased CVD risk. Herein, we aim to provide a balanced update on this topic. RECENT FINDINGS: In 2021, the Salt Substitute and Stroke Study (SSaSS) demonstrated a significant reduction in BP, CVD, and death among Chinese adults randomized to a low sodium salt-substitute supplemented with potassium. This trial largely puts to rest any remaining debate about the benefits of dietary sodium restriction among persons with excess baseline intake (dietary sodium intake fell from approximately 5 down to 4 g/day in the active arm of SSaSS). However, whether achieving and maintaining a dietary sodium of less than1.5 g/day is feasible in real-world settings and whether this low an intake is harmful remain open questions. SUMMARY: Aiming for sodium intakes of 2--3 g/day in the general population and as low as 2 g/day in persons with hypertension or CVD seems most reasonable, but there is some uncertainty around lower targets.

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