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Hypertension. 2018 May;71(5):858-865. doi: 10.1161/HYPERTENSIONAHA.117.10602. Epub 2018 Mar 19.

Relationship of Sodium Intake and Blood Pressure Varies With Energy Intake: Secondary Analysis of the DASH (Dietary Approaches to Stop Hypertension)-Sodium Trial.

Author information

1
From the Division of Epidemiology, Department of Medicine (M.A.M., T.G., M.M.) and Department of Nutrition and Integrative Physiology (P.M.G.), University of Utah, Salt Lake City; Department of Medicine, New York University School of Medicine (J.M.B.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.); and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (J.A.T.). Maureen.Murtaugh@hsc.utah.edu.
2
From the Division of Epidemiology, Department of Medicine (M.A.M., T.G., M.M.) and Department of Nutrition and Integrative Physiology (P.M.G.), University of Utah, Salt Lake City; Department of Medicine, New York University School of Medicine (J.M.B.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.); and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (J.A.T.).

Abstract

Dietary Na recommendations are expressed as absolute amounts (mg/d) rather than as Na density (mg/kcal). Our objective was to determine whether the strength of the relationship of Na intake with blood pressure (BP) varied with energy intake. The DASH (Dietary Approaches to Stop Hypertension)-Sodium trial was a randomized feeding trial comparing 2 diets (DASH and control) and 3 levels of Na density. Participants with pre- or stage 1 hypertension consumed diets for 30 days in random order; energy intake was controlled to maintain body weight. This secondary analysis of 379 non-Hispanic black and white participants used mixed-effects models to assess the association of Na and energy intakes with BP. The relationships between absolute Na and both systolic and diastolic BP varied with energy intake. BP rose more steeply with increasing Na at lower energy intake than at higher energy intake (P interaction<0.001). On the control diet with 2300 mg Na, both systolic and diastolic BP were higher (3.0 mm Hg; 95% confidence interval, 0.2-5.8; and 2.7 mm Hg; 95% confidence interval, 1.0-4.5, respectively) among those with lower energy intake (higher Na density) than among those with higher energy intake (lower Na density). The association of Na with systolic BP was stronger at lower levels of energy intake in both blacks and whites (P<0.001). The association of Na and diastolic BP varied with energy intake only among blacks (P=0.001). Sodium density should be considered as a metric for expressing dietary Na recommendations.

KEYWORDS:

blood pressure; body weight; diet; energy intake; hypertension; sodium

PMID:
29555665
PMCID:
PMC5897169
DOI:
10.1161/HYPERTENSIONAHA.117.10602
[Indexed for MEDLINE]
Free PMC Article

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