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Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations

^a Department of Epidemiology and Public Health, Imperial College School of Medicine at St Mary's, London W2 1PG, ^b Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL 60611-4402, USA, ^c Department of Epidemiology, St Raphael University Hospital, Leuven, Belgium, ^d Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT

Correspondence to: Professor Elliott. p.elliott{at}ic.ac.uk.

Abstract

Objectives: To assess further the relation in Intersalt of 24 hour urinary sodium to blood pressure of individuals and populations, and the difference in blood pressure from young adulthood into middle age.
Design: Standardised cross sectional study within and across populations.
Setting: 52 population samples in 32 countries.
Subjects: 10 074 men and women aged 20-59.
Main outcome measures: Association of sodium and blood pressure from within population and cross population multiple linear regression analyses with multivariate correction for regression dilution bias. Relation of sample median daily urinary sodium excretion to difference in blood pressure with age.
Results: In within population analyses (n=10 074), individual 24 hour urinary sodium excretion higher by 100 mmol (for example, 170 v 70 mmol) was associated with systolic/diastolic blood pressure higher on average by 3/0 to 6/3 mm Hg (with and without body mass in analyses). Associations were larger at ages 40-59. In cross population analyses (n=52), sample median 24 hour sodium excretion higher by 100 mmol was associated with median systolic/diastolic pressure higher on average by 5-7/2-4 mm Hg, and estimated mean difference in systolic/diastolic pressure at age 55 compared with age 25 greater by 10-11/6 mm Hg.
Conclusions: The strong, positive association of urinary sodium with systolic pressure of individuals concurs with Intersalt cross population findings and results of other studies. Higher urinary sodium is also associated with substantially greater differences in blood pressure in middle age compared with young adulthood. These results support recommendations for reduction of high salt intake in populations for prevention and control of adverse blood pressure levels.

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• Norat, T., Bowman, R., Luben, R., Welch, A., Khaw, K. T., Wareham, N., Bingham, S. (2008). Blood pressure and interactions between the angiotensin polymorphism AGT M235T and sodium intake: a cross-sectional population study. Am. J. Clin. Nutr. 88: 392-397 [Abstract] [Full text]  
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• Harsha, D. W., Bray, G. A. (2008). Weight Loss and Blood Pressure Control (Pro). Hypertension 51: 1420-1425 [Full text]  
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• Gaziano, T A (2008). Economic burden and the cost-effectiveness of treatment of cardiovascular diseases in Africa. Heart 94: 140-144 [Abstract] [Full text]  
• Varagic, J., Frohlich, E. D., Susic, D., Ahn, J., Matavelli, L., Lopez, B., Diez, J. (2008). AT1 receptor antagonism attenuates target organ effects of salt excess in SHRs without affecting pressure. Am. J. Physiol. Heart Circ. Physiol. 294: H853-H858 [Abstract] [Full text]  
• Zhu, H., Yan, W., Ge, D., Treiber, F. A., Harshfield, G. A., Kapuku, G., Snieder, H., Dong, Y. (2008). Relationships of Cardiovascular Phenotypes With Healthy Weight, at Risk of Overweight, and Overweight in US Youths. Pediatrics 121: 115-122 [Abstract] [Full text]  
• Walker, J., MacKenzie, A. D., Dunning, J. (2007). Does reducing your salt intake make you live longer?. ICVTS 6: 793-798 [Abstract] [Full text]  
• Elliott, P., Walker, L. L., Little, M. P., Blair-West, J. R., Shade, R. E., Lee, D. R., Rouquet, P., Leroy, E., Jeunemaitre, X., Ardaillou, R., Paillard, F., Meneton, P., Denton, D. A. (2007). Change in Salt Intake Affects Blood Pressure of Chimpanzees: Implications for Human Populations. Circulation 116: 1563-1568 [Abstract] [Full text]  
• Gu, D., Rice, T., Wang, S., Yang, W., Gu, C., Chen, C.-S., Hixson, J. E., Jaquish, C. E., Yao, Z.-J., Liu, D.-P., Rao, D. C., He, J. (2007). Heritability of Blood Pressure Responses to Dietary Sodium and Potassium Intake in a Chinese Population. Hypertension 50: 116-122 [Abstract] [Full text]  
• Balsamo, A., Cicognani, A., Gennari, M., Sippell, W. G, Menabo, S., Baronio, F., Riepe, F. G (2007). Functional characterization of naturally occurring NR3C2 gene mutations in Italian patients suffering from pseudohypoaldosteronism type 1. Eur J Endocrinol 156: 249-256 [Abstract] [Full text]  
• Jia, Z., Zhang, A., Zhang, H., Dong, Z., Yang, T. (2006). Deletion of Microsomal Prostaglandin E Synthase-1 Increases Sensitivity to Salt Loading and Angiotensin II Infusion. Circ. Res. 99: 1243-1251 [Abstract] [Full text]  
• Franco, V., Oparil, S. (2006). Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival.. J. Am. Coll. Nutr. 25: 247S-255S [Abstract] [Full text]  
• Hodgson, J. M, Burke, V., Beilin, L. J, Puddey, I. B (2006). Partial substitution of carbohydrate intake with protein intake from lean red meat lowers blood pressure in hypertensive persons.. Am. J. Clin. Nutr. 83: 780-787 [Abstract] [Full text]  
• Laaser, U., Breckenkamp, J. (2006). Trends in risk factor control in Germany 1984-1998: high blood pressure and total cholesterol. Eur J Public Health 16: 217-222 [Abstract] [Full text]  
• Skov, K., Madsen, J. K., Hansen, H. E., Zagato, L., Frandsen, E., Bianchi, G., Mulvany, M. J. (2006). Renal Haemodynamics are not Related to Genotypes in Offspring of Parents with Essential Hypertension. Journal of Renin-Angiotensin-Aldosterone System 7: 47-55 [Abstract]  
• Iwamoto, T. (2006). Vascular Na+/Ca2+ exchanger: implications for the pathogenesis and therapy of salt-dependent hypertension. Am. J. Physiol. Regul. Integr. Comp. Physiol. 290: R536-R545 [Abstract] [Full text]  
• Elliott, P., Stamler, J., Dyer, A. R., Appel, L., Dennis, B., Kesteloot, H., Ueshima, H., Okayama, A., Chan, Q., Garside, D. B., Zhou, B., for the INTERMAP Cooperative Research Group, (2006). Association Between Protein Intake and Blood Pressure: The INTERMAP Study. Arch Intern Med 166: 79-87 [Abstract] [Full text]  
• Farquhar, W. B., Paul, E. E., Prettyman, A. V., Stillabower, M. E. (2005). Blood pressure and hemodynamic responses to an acute sodium load in humans. J. Appl. Physiol. 99: 1545-1551 [Abstract] [Full text]  
• Elliott, P. (2005). Commentary: Role of salt intake in the development of high blood pressure. Int J Epidemiol 34: 975-978 [Full text]  
• Svetkey, L. P. (2005). Management of Prehypertension. Hypertension 45: 1056-1061 [Full text]  
• Johnson, R. J., Rodriguez-Iturbe, B., Nakagawa, T., Kang, D.-H., Feig, D. I., Herrera-Acosta, J. (2005). Subtle Renal Injury Is Likely a Common Mechanism for Salt-Sensitive Essential Hypertension. Hypertension 45: 326-330 [Full text]  
• Ezzati, M., Utzinger, J., Cairncross, S., Cohen, A. J, Singer, B. H (2005). Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies. J. Epidemiol. Community Health 59: 15-22 [Abstract] [Full text]  
• Tian, Y., Serino, R., Verbalis, J. G. (2004). Downregulation of renal vasopressin V2 receptor and aquaporin-2 expression parallels age-associated defects in urine concentration. Am. J. Physiol. Renal Physiol. 287: F797-F805 [Abstract] [Full text]  
• Nowson, C. A., Worsley, A., Margerison, C., Jorna, M. K., Frame, A. G., Torres, S. J., Godfrey, S. J. (2004). Blood Pressure Response to Dietary Modifications in Free-Living Individuals. J. Nutr. 134: 2322-2329 [Abstract] [Full text]  
• Gates, P. E., Tanaka, H., Hiatt, W. R., Seals, D. R. (2004). Dietary Sodium Restriction Rapidly Improves Large Elastic Artery Compliance in Older Adults With Systolic Hypertension. Hypertension 44: 35-41 [Abstract] [Full text]  
• Merlo, J., Asplund, K., Lynch, J., Rastam, L., Dobson, A. (2004). Population Effects on Individual Systolic Blood Pressure: A Multilevel Analysis of the World Health Organization MONICA Project. Am J Epidemiol 159: 1168-1179 [Abstract] [Full text]  
• Chiplonkar, S. A., Agte, V. V., Tarwadi, K. V., Paknikar, K. M., Diwate, U. P. (2004). Micronutrient Deficiencies as Predisposing Factors for Hypertension in Lacto-Vegetarian Indian Adults. J. Am. Coll. Nutr. 23: 239-247 [Abstract] [Full text]  
• Zhao, L., Stamler, J., Yan, L. L., Zhou, B., Wu, Y., Liu, K., Daviglus, M. L., Dennis, B. H., Elliott, P., Ueshima, H., Yang, J., Zhu, L., Guo, D., for the INTERMAP Research Group, (2004). Blood Pressure Differences Between Northern and Southern Chinese: Role of Dietary Factors: The International Study on Macronutrients and Blood Pressure. Hypertension 43: 1332-1337 [Abstract] [Full text]  
• Jones, D. W. (2004). Dietary Sodium and Blood Pressure. Hypertension 43: 932-935 [Full text]  
• Claydon, V. E., Hainsworth, R. (2004). Salt Supplementation Improves Orthostatic Cerebral and Peripheral Vascular Control in Patients With Syncope. Hypertension 43: 809-813 [Abstract] [Full text]  
• DeCrane, S. K. (2004). Have We Underestimated the Effects of Sodium Excess on the Health of the Public?. Policy Politics Nursing Practice 5: 25-33 [Abstract]  
• Forrester, T. (2004). Historic and Early Life Origins of Hypertension in Africans. J. Nutr. 134: 211-216 [Abstract] [Full text]  
• Nowson, C. A., Morgan, T. O., Gibbons, C. (2003). Decreasing Dietary Sodium While Following a Self-Selected Potassium-Rich Diet Reduces Blood Pressure. J. Nutr. 133: 4118-4123 [Abstract] [Full text]  
• Flack, J. M., Peters, R., Shafi, T., Alrefai, H., Nasser, S. A., Crook, E. (2003). Prevention of Hypertension and Its Complications: Theoretical Basis and Guidelines for Treatment. J. Am. Soc. Nephrol. 14: S92-98 [Abstract] [Full text]  
• Hajjar, I., Kotchen, T. (2003). Regional Variations of Blood Pressure in the United States Are Associated with Regional Variations in Dietary Intakes: The NHANES-III Data. J. Nutr. 133: 211-214 [Abstract] [Full text]  
• He, J., Ogden, L. G., Bazzano, L. A., Vupputuri, S., Loria, C., Whelton, P. K. (2002). Dietary Sodium Intake and Incidence of Congestive Heart Failure in Overweight US Men and Women: First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Arch Intern Med 162: 1619-1624 [Abstract] [Full text]  
• Melander, O., Frandsen, E., Groop, L., Hulthen, U. L. (2002). Plasma ProANP1-30 Reflects Salt Sensitivity in Subjects With Heredity for Hypertension. Hypertension 39: 996-999 [Abstract] [Full text]  
• Elliott, P., Stamler, J. (2002). Commentary: Evidence on salt and blood pressure is consistent and persuasive. Int J Epidemiol 31: 316-319 [Full text]  
• He, J., Whelton, P. K (2002). Commentary: Salt intake, hypertension and risk of cardiovascular disease: an important public health challenge. Int J Epidemiol 31: 327-331 [Full text]  
• Young, L., Swinburn, B. (2002). Impact of the Pick the Tick food information programme on the salt content of food in New Zealand. HEALTH PROMOT INT 17: 13-19 [Abstract] [Full text]  
• Liu, L., Ikeda, K., Yamori, Y. (2002). Inverse relationship between urinary markers of animal protein intake and blood pressure in Chinese: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. Int J Epidemiol 31: 227-233 [Abstract] [Full text]  
• He, F. J, MacGregor, G. A (2001). Salt -- The DASH-Sodium trial. Journal of Renin-Angiotensin-Aldosterone System 2: 93-95  
• Chiolero, A., Wurzner, G., Burnier, M. (2001). Renal determinants of the salt sensitivity of blood pressure. Nephrol Dial Transplant 16: 452-458 [Full text]  
• Hajjar, I. M., Grim, C. E., George, V., Kotchen, T. A. (2001). Impact of Diet on Blood Pressure and Age-Related Changes in Blood Pressure in the US Population: Analysis of NHANES III. Arch Intern Med 161: 589-593 [Abstract] [Full text]  
• Wilsgaard, T., Schirmer, H., Arnesen, E. (2000). Impact of Body Weight on Blood Pressure With a Focus on Sex Differences: The Tromso Study, 1986-1995. Arch Intern Med 160: 2847-2853 [Abstract] [Full text]  
• Kaplan, N. M (2000). The dietary guideline for sodium: should we shake it up? No. Am. J. Clin. Nutr. 71: 1020-1026 [Abstract] [Full text]  
• Chobanian, A. V., Hill, M. (2000). National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure : A Critical Review of Current Scientific Evidence. Hypertension 35: 858-863 [Full text]  
• CHEUNG, B.M.Y., HO, S.P.C., CHEUNG, A.H.K., LAU, C.P. (2000). Diastolic blood pressure is related to urinary sodium excretion in hypertensive Chinese patients. QJM 93: 163-168 [Abstract] [Full text]  
• Everson, S. A., Kaplan, G. A., Goldberg, D. E., Salonen, J. T. (2000). Hypertension Incidence Is Predicted by High Levels of Hopelessness in Finnish Men. Hypertension 35: 561-567 [Abstract] [Full text]  
• Alderson, T. S. J., Ogden, J. (1999). What do mothers feed their children and why?. Health Educ Res 14: 717-727 [Abstract] [Full text]  
• Logan, A. G., He, F. J., Markandu, N. D., Sagnella, G. A., MacGregor, G. A. (1999). Study Duration and Validity • Response. Hypertension 34 : e11-e11 [Full text]  
• Tracy, R.E. (1999). Salt, obesity, and alcohol fail to induce a lasting rise of blood pressure with age, and may be independent of renocortical vasculopathy. QJM 92: 601-607 [Abstract] [Full text]  
• Jula, A., Salminen, J. K., Saarijarvi, S. (1999). Alexithymia : A Facet of Essential Hypertension. Hypertension 33: 1057-1061 [Abstract] [Full text]  
• Kotchen, T. A., McCarron, D. A. (1998). Dietary Electrolytes and Blood Pressure : A Statement for Healthcare Professionals From the American Heart Association Nutrition Committee. Circulation 98: 613-617 [Full text]  
• Graudal, N. A., Galloe, A. M., Garred, P. (1998). Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride: A Meta-analysis. JAMA 279: 1383-1391 [Abstract] [Full text]  
• Whelton, P. K., Appel, L. J., Espeland, M. A., Applegate, W. B., Ettinger, W. H. Jr, Kostis, J. B., Kumanyika, S., Lacy, C. R., Johnson, K. C., Folmar, S., Cutler, J. A., for the TONE Collaborative Research Group, (1998). Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE). JAMA 279: 839-846 [Abstract] [Full text]  
• Stamler, J. (1998). Setting the TONE for Ending the Hypertension Epidemic. JAMA 279: 878-879 [Full text]  
• Weinberger, M. H. (1997). More Spice on the Salt Debate. Arch Intern Med 157: 2407-2408 [Abstract]  
• (1997). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 157: 2413-2446 [Abstract]  
• Messerli, F. H., Schmieder, R. E., Weir, M. R. (1997). Salt: A Perpetrator of Hypertensive Target Organ Disease?. Arch Intern Med 157: 2449-2452 [Abstract]  
• Le Fanu, J., Alderman, M., Macnair, A., Day, N E, Smith, G. D., Phillips, A. N, Watt, G., Hart, J. T., Rennolls, K., Elliott, P., Stamler, J., Dyer, A. R, Stamler, R., Kesteloot, H., Marmot, M., Grimm, R. H, Liebman, B. F, Jacobson, M. F (1997). Intersalt data. BMJ 315: 484-484 [Full text]  
• Kiefe, C. I., Williams, O. D., Bild, D. E., Lewis, C. E., Hilner, J. E., Oberman, A. (1997). Regional Disparities in the Incidence of Elevated Blood Pressure Among Young Adults : The CARDIA Study. Circulation 96: 1082-1088 [Abstract] [Full text]  
• Mervaala, E. M.A., Pere, A.-K., Lindgren, L., Laakso, J., Teravainen, T.-L., Karjala, K., Vapaatalo, H., Ahonen, J., Karppanen, H. (1997). Effects of Dietary Sodium and Magnesium on Cyclosporin A–Induced Hypertension and Nephrotoxicity in Spontaneously Hypertensive Rats. Hypertension 29: 822-827 [Abstract] [Full text]  
• Stamler, J., Caggiula, A., Grandits, G. A., Kjelsberg, M., Cutler, J. A. (1996). Relationship to Blood Pressure of Combinations of Dietary Macronutrients: Findings of the Multiple Risk Factor Intervention Trial (MRFIT). Circulation 94: 2417-2423 [Abstract] [Full text]  
• Stamler, J. (1996). Dietary Sodium and Blood Pressure. JAMA 276: 1467-1467 [Abstract]  
• Kotchen, T. A., Krauss, R. M. (1996). Dietary Sodium and Blood Pressure. JAMA 276: 1468-1468 [Abstract]  
• Stamler, J., Elliott, P., Kesteloot, H., Nichols, R., Claeys, G., Dyer, A.R., Stamler, R. (1996). Inverse Relation of Dietary Protein Markers With Blood Pressure: Findings for 10 020 Men and Women in the INTERSALT Study. Circulation 94: 1629-1634 [Abstract] [Full text]  
• Krauss, R. M., Deckelbaum, R. J., Ernst, N., Fisher, E., Howard, B. V., Knopp, R. H., Kotchen, T., Lichtenstein, A. H., McGill, H. C., Pearson, T. A., Prewitt, T. E., Stone, N. J., Van Horn, L., Weinberg, R. (1996). Dietary Guidelines for Healthy American Adults: A Statement for Health Professionals From the Nutrition Committee, American Heart Association. Circulation 94: 1795-1800 [Full text]  
• (1996). DOES SALT INTAKE PREDICT BLOOD PRESSURE?. JWatch General 1996: 2-2 [Full text]  
• Godlee, F. (1996). The food industry fights for salt. BMJ 312: 1239-1240 [Full text]  
• Delamothe, T. (1996). Whose data are they anyway?. BMJ 312: 1241-1242 [Full text]  
• Law, M. (1996). Commentary: Evidence on salt is consistent. BMJ 312: 1284-1285 [Full text]  
• Stamler, J., Elliott, P., Dyer, A. R, Stamler, R., Kesteloot, H., Marmot, M. (1996). Commentary: Sodium and blood pressure in the Intersalt study and other studies--in reply to the Salt Institute. BMJ 312: 1285-1287 [Full text]