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BMJ No 7106 Volume 315 Letters Saturday 23 August 1997 Intersalt dataCollaborative efforts must be made to reduce sodium in dietEditor,The article by Richard L Hanneman was entertaining in its demonstration of the lengths to which the food industry, specifically the Salt Institute, will go to obfuscate and confuse the question of salt's relation to blood pressure.(1) The criticisms in the article related to the Intersalt study(2) have been extensively covered, and it would be redundant to review these again. However, the important and extensive area of evidence from clinical trials has largely been ignored by Hanneman and the Salt Institute. The Shapiro Center for Evidence-Based Medicine has been working in clinical trials of sodium reduction and blood pressure for 20 years. Earlier trials on sodium reduction combined with other lifestyle changes (weight loss, alcohol reduction) showed the usefulness of sodium reduction in removing and minimising the need for blood pressure drugs in hypertensive patients who had previously been treated for years with such drugs.(3) More recently, the centre has conducted double blind crossover trials of sodium supplementation in white and black normotensive subjects, which showed that reducing sodium intake and giving back sodium in levels similar to average daily sodium intake will significantly influence blood pressure.(4) Other studies have confirmed these results.(5) Dietary sodium intake is clearly a major determinant of blood pressure based on epidemiological data (that is, data from the Intersalt study) confirmed by prospective, randomised, placebo controlled trials. Let's stop debating what for some time has been ridiculously obvious; let's move on to working collaboratively to reduce the sodium in the diet (which is ingested largely in the form of processed foods and fast foods) so that the population at large will benefit. Richard H Grimm Director
Shapiro Center for Evidence-Based Medicine, References 1 Hanneman R L. Intersalt: hypertension rise with age revisited. [With commentaries by M Law and J Stamler et al.] BMJ 1996;312:1283-7. 2 Elliott P, Stamler J, Nichols R, Dyer A R, Stamler R, Kesteloot H, et al for the Intersalt Cooperative Research Group. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ 1996;312:1249-53. 3 Stamler R, Stamler J, Grimm R, Gosch F, Elmer P, Dyer A, et al. Nutritional therapy for high blood pressure: final report of a 4-year randomized control trial. The hypertension control program. JAMA 1987;257:1484-91. 4 Mascioli S, Grimm R, Launer C A, Svendsen K, Flack J M, Gonzalez N, et al. Sodium chloride raises blood pressure in normotensive subjects: the study of sodium and blood pressure. Hypertension 1991;17(suppl I):121-6. 5 Grimm R, Shaten B J, Elmer P J, Flack I M, Holland L, Matts J P, et al for the SNaP Research Group. Effects of sodium supplementation in blacks on blood pressure and other metabolic measures [abstract]. J Hypertens 1996; in press.
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