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

被引:156
作者
Graudal, Niels Albert [1 ]
Hubeck-Graudal, Thorbjorn [2 ]
Jurgens, Gesche [3 ]
机构
[1] Rigshosp, Dept Rheumatol VRR4242, Copenhagen Univ Hosp, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark
[2] Herning Hosp, Dept Nucl Med, Herning, Denmark
[3] Roskilde Hosp, Clin Pharmacol Unit, Roskilde, Denmark
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2017年 / 04期
关键词
Diet; Sodium-Restricted; African Continental Ancestry Group; Aldosterone [blood; Asian Continental Ancestry Group; Blood Pressure [drug effects; radiation effects; Catecholamines [blood; Cholesterol [blood; European Continental Ancestry Group; Hypertension [diet therapy; ethnology; Randomized Controlled Trials as Topic; Renin [blood; Sodium Chloride; Dietary [pharmacology; Triglycerides [blood; Humans; MODERATE SALT RESTRICTION; ATRIAL-NATRIURETIC-PEPTIDE; CONVERTING-ENZYME-INHIBITOR; DIETARY NACL RESTRICTION; NITRIC-OXIDE PRODUCTION; ALL-CAUSE MORTALITY; URINARY SODIUM; DOUBLE-BLIND; HYPERTENSIVE PATIENTS; INSULIN SENSITIVITY;
D O I
10.1002/14651858.CD004022.pub4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background In spite of more than 100 years of investigations the question of whether a reduced sodium intake improves health is still unsolved. Objectives To estimate the effects of low sodium intake versus high sodium intake on systolic and diastolic blood pressure (SBP and DBP), plasma or serum levels of renin, aldosterone, catecholamines, cholesterol, high- density lipoprotein (HDL), low- density lipoprotein (LDL) and triglycerides. Search methods The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to March 2016: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 3), MEDLINE (from 1946), Embase (from 1974), theWorld Health Organization International Clinical Trials Registry Platform, and ClinicalTrials. gov. We also searched the reference lists of relevant articles. Selection criteria Studies randomising persons to low-sodium and high- sodium diets were included if they evaluated at least one of the above outcome parameters. Data collection and analysis Two review authors independently collected data, which were analysed with Review Manager 5.3. Main results A total of 185 studies were included. The average sodium intake was reduced from 201 mmol/day (corresponding to high usual level) to 66 mmol/day (corresponding to the recommended level). The effect of sodium reduction on blood pressure (BP) was as follows: white people with normotension: SBP: mean difference (MD) -1.09 mmHg (95% confidence interval (CI): -1.63 to -0.56; P = 0.0001); 89 studies, 8569 participants; DBP: + 0.03 mmHg (MD 95% CI: -0.37 to 0.43; P = 0.89); 90 studies, 8833 participants. High-quality evidence. Black people with normotension: SBP: MD -4.02 mmHg (95% CI:-7.37 to -0.68; P = 0.002); seven studies, 506 participants; DBP: MD -2.01 mmHg (95% CI:-4.37 to 0.35; P = 0.09); seven studies, 506 participants. Moderate-quality evidence. Asian people with normotension: SBP: MD -0.72 mmHg (95% CI: -3.86 to 2.41; P = 0.65); DBP: MD -1.63 mmHg (95% CI:-3.35 to 0.08; P = 0.06); three studies, 393 participants. Moderate-quality evidence. White people with hypertension: SBP: MD -5.51 mmHg (95% CI: -6.45 to -4.57; P < 0.00001); 84 studies, 5925 participants; DBP: MD -2.88 mmHg (95% CI: -3.44 to -2.32; P < 0.00001); 85 studies, 6001 participants. High-quality evidence. Black people with hypertension: SBP MD -6.64 mmHg (95% CI:-9.00 to -4.27; P = 0.00001); eight studies, 619 participants; DBP -2.91 mmHg (95% CI:-4.52, -1.30; P = 0.0004); eight studies, 619 participants. Moderate-quality evidence. Asian people with hypertension: SBP: MD -7.75 mmHg (95% CI:-11,44 to -4.07; P < 0.0001) nine studies, 501 participants; DBP: MD -2.68 mmHg (95% CI: -4.21 to -1.15; P = 0.0006). Moderate-quality evidence. In plasma or serum, there was a significant increase in renin (P < 0.00001), aldosterone (P < 0.00001), noradrenaline (P < 0.00001), adrenaline (P < 0.03), cholesterol (P < 0.0005) and triglyceride (P < 0.0006) with low sodium intake as compared with high sodium intake. All effects were stable in 125 study populations with a sodium intake below 250 mmol/day and a sodium reduction intervention of at least one week. Authors' conclusions Sodium reduction from an average high usual sodium intake level (201 mmol/day) to an average level of 66 mmol/day, which is below the recommended upper level of 100 mmol/day (5.8 g salt), resulted in a decrease in SBP/DBP of 1/0 mmHg in white participants with normotension and a decrease in SBP/DBP of 5.5/2.9 mmHg in white participants with hypertension. A few studies showed that these effects in black and Asian populations were greater. The effects on hormones and lipids were similar in people with normotension and hypertension. Renin increased 1.60 ng/mL/hour (55%); aldosterone increased 97.81 pg/mL (127%); adrenalin increased 7.55 pg/ mL (14%); noradrenalin increased 63.56 pg/mL: (27%); cholesterol increased 5.59 mg/dL (2.9%); triglyceride increased 7.04 mg/dL (6.3%).
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