BMJ 1994;309:436-40 (13 August)

Papers

Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension

J M Geleijnse, J C M Witteman, A A A Bak, J H den Breijen, D E Grobbee 

Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, Netherlands Correspondence to: Mrs J M Geleijnse,.

Abstract

Objective : To examine the effect of a reduced sodium and increased potassium and magnesium intake on blood pressure.
Design : Randomised double blind placebo controlled trial.
Setting : General population of a suburb of Rotterdam.
Subjects : 100 men and women between 55 and 75 years of age with untreated mild to moderate hypertension.
Interventions : During 24 weeks the intervention group received a mineral salt (sodium: potassium: magnesium 8:6:1) and foods prepared with the mineral salt. Controls received common salt and foods.
Main outcome measure : Change in blood pressure. Results - Complete follow up was achieved for 97 of the 100 randomised subjects. Systolic blood pressure (mean of measurements at weeks 8, 16, and 24) fell by 7.6 mm Hg (95% confidence interval 4.0 to 11.2) and diastolic blood pressure by 3.3 mm Hg (0.8 to 5.8) in the mineral salt group compared with the controls, with a 28% decrease in urinary sodium excretion and a 22% increase in urinary potassium excretion. Twenty five weeks after the study the difference in blood pressure between the groups was no longer detectable.
Conclusion : Replacing common sodium salt by a low sodium, high potassium, high magnesium mineral salt could offer a valuable non -pharmacological approach to lowering blood pressure in older people with mild to moderate hypertension.

Clinical implications

  • Clinical implications

  • Hypertension is common among older subjects and a well established risk factor for stroke and heart disease

  • Diet affects blood pressure, and changes in diet are recommended as initial, non-pharmacological measures to lower raised blood pressure

  • In this study a fall in blood pressure of 8 mm Hg systolic and 3 mm Hg diastolic was achieved by replacing common salt by a low sodium, high potassium, high magnesium mineral salt

  • The diet in the trial remained largely unchanged, and the alternative salt and foods were palatable and well accepted by participants

  • In the initial management of raised blood pressure it may be easier and more effective to provide a mineral salt than to get patients to restrict salt intake or to take a pure potassium chloride salt substitute


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