The hypertension controversy

Suggesting that there might be controversy in the link between salt intake and hypertension in itself might seem a little controversial, given the vast amount of media attention that our salt intake has received over recent years. But controversial it is.

Some 45 published papers on ‘salt and hypertension’ were uploaded onto the CAB Abstracts database in 2006 alone. Sticking to these, by way of example, it seems that the more sophisticated our analytical techniques become, the weaker the relationship between sodium intake and high blood pressure appears to be in the general population (Franco and Oparil, 2006). In fact, these authors report that the effects of reducing salt intake on blood pressure highly variable between individuals. Some people’s blood pressure responds quite dramatically even to small changes in salt intake – these individuals have been dubbed ‘salt sensitive’. It seems that salt sensitivity itself has a large number of determinants, including genetic factors, race/ethnicity, age, body mass and dietary factors in addition to sodium level.

Dickinson and colleagues (2006), on the other hand, conducted a ‘systematic review of randomised controlled trials’ and concluded that a number of factors were able to have a beneficial influence over blood pressure in hypertensive patients. These factors included improving diet, doing aerobic exercise, alcohol and sodium restriction and the use of fish oils supplements. Or, as Norman Hollenberg of Brigham and Women’s Hospital and

Harvard

Medical

School

so eloquently put it: ‘At the level of the individual patient and that patient’s physician, it is important to recognize that salt intake can make a substantial contribution to hypertension. That contribution is more likely if the patient is old rather than young, obese rather than lean, black rather than white, has diabetes mellitus with hypertension, or has evidence of renal injury.’

Adding fuel to the fires of controversy, Yalcin Tekol of Erciyes University Medical Faculty in

Turkey

recently argued that all this debate about how or how much link there is between sodium intake and high blood pressure was wasting time in combating the problem. His belief is that the minimum dietary level of salt that can produce hypertension is 1.76g/day. Far lower than the 6g per day we are all worrying about trying to reduce our intake too. Tekol thus recommends that salt be treated as a drug and as such really should not be permitted to be added to food in the first place. More on this later.

References

Tekol, Y (2006). Is systemic hypertension only a sign of chronic sodium chloride intoxication? Medical Hypotheses, Vol. 67, No. 3, pp. 630-638.

Hollenberg, N.K. (2006). The influence of dietary sodium on blood pressure. Journal of the American College of Nutrition, Vol. 25, No. 3(S), pp. 240S-246S.

Dickinson et al. (2006). Lifestyle interventions to reduce raised blood pressure: a systematic review of randomised controlled trials. Journal of Hypertension, Vol. 24, No. 2, pp. 215-233.

Franco, V. and Oparil, S. (2006). Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival. Journal of the American College

of Nutrition, Vol. 25, No. 3(S), pp. 247S-255S.

Comments

[Jefrey Dach MD]

Hypertension,When to Treat?

The 18 year Framingham Blood Pressure study found increased risk of heart disease and death in people with increased blood pressure 140 to 160, and even more risk above 160.

If you examine the original data from the Framingham study, you will find computer smoothing of the data as published in the medical journals. This gives a smooth gradual line of increasing mortality as blood pressure goes up between 140 and 160. This is called the Linear Model. However, if you examine the raw data, as S. Port did as published in Lancet 1/15/2000, you will find a non-linear threshold of increased risk above 160 systolic, and no increased mortality below 160.

For a more complete review of this controversy in Blood Pressure guidelines, see my newsletter

Blood Pressure Pills for Hypertension, When to Treat? by Jeffrey Dach MD
http://jeffreydach.com/2007/07/22/blood-pressure-pills-for-hypertension-when-to-treat--by-jeffrey-dach-md.aspx

http://www.drdach.com

Jeffrey Dach MD

[michael jones]

I was searching for some information about the salt and its reflection on our high blood pressure! Thank you for the good post!

[Blood Pressure Numbers]

Wow...the relationship between salt and blood pressure is almost sacred as far as the medical community is concerned.

[High Blood Pressure]

Alistrol provides an absolute solution for avoiding high blood pressure symptom by giving services of natural high blood pressure supplement.

[Alexis Kenne]

It was previously referred to as arterial hypertension, but in current usage, the word “hypertension” without a qualifier normally refers to arterial hypertension. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. People with hypertension or history of cardio-vascular disease should avoid Liquorice raising their blood pressure to risky levels. Relaxation therapy, such as meditation, that reduces environmental stress, reducing high sound levels and over-illumination can be an additional method of ameliorating hypertension.

[Alexis Kenne]

Hypertension, most commonly referred to as “high blood pressure”,HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. Hypertension can be classified as either essential (primary) or secondary. Hypertension is considered to be present when a person’s systolic blood pressure is consistently 140 mmHg or greater, and/or their diastolic blood pressure is consistently 90 mmHg or greater. Hypertension is one of the most common complex disorders, with genetic heritability averaging 30%. Hypertension can also be produced by diseases of the renal arteries supplying the kidney.

[peter]

I am always careful about these type of issue.. Thank you.

[coach purses]

Some people insist that only today and tomorrow matter. But how much poorer we would be if we really lived by that rule! So much of what we do today is frivolous and futile and soon forgotten. So much of what we hope to do tomorrow never happens.