Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1999 May 4;160(9):S29–S34.

Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada

JG Fodor 1, B Whitmore 1, F Leenen 1, P Larochelle 1
PMCID: PMC1230337  PMID: 10333851

Abstract

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of dietary salt intake on the prevention and control of hypertension in adults (except pregnant women). The guidelines are intended for use in clinical practice and public education campaigns. OPTIONS: Restriction of dietary salt intake may be an alternative to antihypertensive medications or may supplement such medications. Other options include other nonpharmacologic treatments for hypertension and no treatment. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 using the terms hypertension, blood pressure, vascular resistance, sodium chloride, sodium, diet, sodium or sodium chloride dietary, sodium restricted/reducing diet, clinical trials, controlled clinical trial, randomized controlled trial and random allocation. Both trials and review articles were obtained, and other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. In addition, a systematic review of all published randomized controlled trials relating to dietary salt intake and hypertension was conducted. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: For normotensive people, a marked change in sodium intake is required to achieve a modest reduction in blood pressure (there is a decrease of 1 mm Hg in systolic blood pressure for every 100 mmol decrease in daily sodium intake). For hypertensive patients, the effects of dietary salt restriction are most pronounced if age is greater than 44 years. A decrease of 6.3 mm Hg in systolic blood pressure and 2.2 mm Hg in diastolic blood pressure per 100 mmol decrease in daily sodium intake was observed in people of this age group. For hypertensive patients 44 years of age and younger, the decreases were 2.4 mm Hg for systolic blood pressure and negligible for diastolic blood pressure. A diet in which salt is moderately restricted appears not to be associated with health risks. RECOMMENDATIONS: (1) Restriction of salt intake for the normotensive population is not recommended at present, because of insufficient evidence demonstrating that this would lead to a reduced incidence of hypertension. (2) To avoid excessive intake of salt, people should be counselled to choose foods low in salt (e.g., fresh fruits and vegetables), to avoid foods high in salt (e.g., pre-prepared foods), to refrain from adding salt at the table and minimize the amount of salt used in cooking, and to increase awareness of the salt content of food choices in restaurants. (3) For hypertensive patients, particularly those over the age of 44 years, it is recommended that the intake of dietary sodium be moderately restricted, to a target range of 90-130 mmol per day (which corresponds to 3-7 g of salt per day). (4) The salt consumption of hypertensive patients should be determined by interview. VALIDATION: These recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth International Conference on Preventive Cardiology. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

Full Text

The Full Text of this article is available as a PDF (198.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderman M. H., Madhavan S., Cohen H., Sealey J. E., Laragh J. H. Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension. 1995 Jun;25(6):1144–1152. doi: 10.1161/01.hyp.25.6.1144. [DOI] [PubMed] [Google Scholar]
  2. Applegate W. B., Miller S. T., Elam J. T., Cushman W. C., el Derwi D., Brewer A., Graney M. J. Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension. Arch Intern Med. 1992 Jun;152(6):1162–1166. [PubMed] [Google Scholar]
  3. Benetos A., Xiao Y. Y., Cuche J. L., Hannaert P., Safar M. Arterial effects of salt restriction in hypertensive patients. A 9-week, randomized, double-blind, crossover study. J Hypertens. 1992 Apr;10(4):355–360. doi: 10.1097/00004872-199204000-00006. [DOI] [PubMed] [Google Scholar]
  4. Bompiani G. D., Cerasola G., Morici M. L., Condorelli M., Trimarco B., De Luca N., Leonetti G., Sampieri L., Cuspidi C., Cottone S. Effects of moderate low sodium/high potassium diet on essential hypertension: results of a comparative study. Int J Clin Pharmacol Ther Toxicol. 1988 Mar;26(3):129–132. [PubMed] [Google Scholar]
  5. Bruun N. E., Skøtt P., Damkjaer Nielsen M., Rasmussen S., Schütten H. J., Leth A., Pedersen E. B., Giese J. Normal renal tubular response to changes of sodium intake in hypertensive man. J Hypertens. 1990 Mar;8(3):219–227. [PubMed] [Google Scholar]
  6. Burnier M., Rutschmann B., Nussberger J., Versaggi J., Shahinfar S., Waeber B., Brunner H. R. Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects. Hypertension. 1993 Sep;22(3):339–347. doi: 10.1161/01.hyp.22.3.339. [DOI] [PubMed] [Google Scholar]
  7. Campbell N. R., Burgess E., Choi B. C., Taylor G., Wilson E., Cléroux J., Fodor J. G., Leiter L. A., Spence D. Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S1–S6. [PMC free article] [PubMed] [Google Scholar]
  8. Cappuccio F. P., Markandu N. D., MacGregor G. A. Calcium antagonists and sodium balance: effect of changes in sodium intake and of the addition of a thiazide diuretic on the blood pressure lowering effect of nifedipine. J Cardiovasc Pharmacol. 1987;10 (Suppl 10):S57–S61. [PubMed] [Google Scholar]
  9. Carney S. L., Gillies A. H., Smith A. J., Waga S. Effect of dietary sodium restriction on patients receiving antihypertensive medication. Clin Exp Hypertens A. 1984;6(6):1095–1105. doi: 10.3109/10641968409039583. [DOI] [PubMed] [Google Scholar]
  10. Carruthers S. G., Larochelle P., Haynes R. B., Petrasovits A., Schiffrin E. L. Report of the Canadian Hypertension Society Consensus Conference: 1. Introduction. CMAJ. 1993 Aug 1;149(3):289–293. [PMC free article] [PubMed] [Google Scholar]
  11. Chalmers J., Morgan T., Doyle A., Dickson B., Hopper J., Mathews J., Matthews G., Moulds R., Myers J., Nowson C. Australian National Health and Medical Research Council dietary salt study in mild hypertension. J Hypertens Suppl. 1986 Dec;4(6):S629–S637. [PubMed] [Google Scholar]
  12. Chockalingam A., Abbott D., Bass M., Battista R., Cameron R., de Champlain J., Evans C. E., Laidlaw J., Lee B. L., Leiter L. Recommendations of the Canadian Consensus Conference on Non-Pharmacological Approaches to the Management of High Blood Pressure, Mar. 21-23, 1989, Halifax, Nova Scotia. CMAJ. 1990 Jun 15;142(12):1397–1409. [PMC free article] [PubMed] [Google Scholar]
  13. Creager M. A., Roddy M. A., Holland K. M., Hirsch A. T., Dzau V. J. Sodium depresses arterial baroreceptor reflex function in normotensive humans. Hypertension. 1991 Jun;17(6 Pt 2):989–996. doi: 10.1161/01.hyp.17.6.989. [DOI] [PubMed] [Google Scholar]
  14. Cutler J. A., Follmann D., Elliott P., Suh I. An overview of randomized trials of sodium reduction and blood pressure. Hypertension. 1991 Jan;17(1 Suppl):I27–I33. doi: 10.1161/01.hyp.17.1_suppl.i27. [DOI] [PubMed] [Google Scholar]
  15. Del Río A., Rodríguez-Villamil J. L. Metabolic effects of strict salt restriction in essential hypertensive patients. J Intern Med. 1993 May;233(5):409–414. doi: 10.1111/j.1365-2796.1993.tb00692.x. [DOI] [PubMed] [Google Scholar]
  16. Donovan D. S., Solomon C. G., Seely E. W., Williams G. H., Simonson D. C. Effect of sodium intake on insulin sensitivity. Am J Physiol. 1993 May;264(5 Pt 1):E730–E734. doi: 10.1152/ajpendo.1993.264.5.E730. [DOI] [PubMed] [Google Scholar]
  17. Du Cailar G., Ribstein J., Daures J. P., Mimran A. Sodium and left ventricular mass in untreated hypertensive and normotensive subjects. Am J Physiol. 1992 Jul;263(1 Pt 2):H177–H181. doi: 10.1152/ajpheart.1992.263.1.H177. [DOI] [PubMed] [Google Scholar]
  18. Erwteman T. M., Nagelkerke N., Lubsen J., Koster M., Dunning A. J. Beta blockade, diuretics, and salt restriction for the management of mild hypertension: a randomised double blind trial. Br Med J (Clin Res Ed) 1984 Aug 18;289(6442):406–409. doi: 10.1136/bmj.289.6442.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Fagerberg B., Andersson O. K., Isaksson B., Björntorp P. Blood pressure control during weight reduction in obese hypertensive men: separate effects of sodium and energy restriction. Br Med J (Clin Res Ed) 1984 Jan 7;288(6410):11–14. doi: 10.1136/bmj.288.6410.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Fotherby M. D., Potter J. F. Effects of moderate sodium restriction on clinic and twenty-four-hour ambulatory blood pressure in elderly hypertensive subjects. J Hypertens. 1993 Jun;11(6):657–663. doi: 10.1097/00004872-199306000-00010. [DOI] [PubMed] [Google Scholar]
  21. Freis E. D. Salt, volume and the prevention of hypertension. Circulation. 1976 Apr;53(4):589–595. doi: 10.1161/01.cir.53.4.589. [DOI] [PubMed] [Google Scholar]
  22. Friberg P., Meredith I., Jennings G., Lambert G., Fazio V., Esler M. Evidence for increased renal norepinephrine overflow during sodium restriction in humans. Hypertension. 1990 Aug;16(2):121–130. doi: 10.1161/01.hyp.16.2.121. [DOI] [PubMed] [Google Scholar]
  23. Fuchs F. D., Wannmacher C. M., Wannmacher L., Guimarães F. S., Rosito G. A., Gastaldo G., Hoeffel C. P., Wagner E. M. Effect of sodium intake on blood pressure, serum levels and renal excretion of sodium and potassium in normotensives with and without familial predisposition to hypertension. Braz J Med Biol Res. 1987;20(1):25–34. [PubMed] [Google Scholar]
  24. Gillum R. F., Elmer P. J., Prineas R. J. Changing sodium intake in children. The Minneapolis Children's Blood Pressure Study. Hypertension. 1981 Nov-Dec;3(6):698–703. doi: 10.1161/01.hyp.3.6.698. [DOI] [PubMed] [Google Scholar]
  25. Gow I. F., Dockrell M., Edwards C. R., Elder A., Grieve J., Kane G., Padfield P. L., Waugh C. J., Williams B. C. The sensitivity of human blood platelets to the aggregating agent ADP during different dietary sodium intakes in healthy men. Eur J Clin Pharmacol. 1992;43(6):635–638. doi: 10.1007/BF02284963. [DOI] [PubMed] [Google Scholar]
  26. Graudal N. A., Galløe A. M., Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998 May 6;279(17):1383–1391. doi: 10.1001/jama.279.17.1383. [DOI] [PubMed] [Google Scholar]
  27. Grobbee D. E., Hofman A., Roelandt J. T., Boomsma F., Schalekamp M. A., Valkenburg H. A. Sodium restriction and potassium supplementation in young people with mildly elevated blood pressure. J Hypertens. 1987 Feb;5(1):115–119. doi: 10.1097/00004872-198702000-00016. [DOI] [PubMed] [Google Scholar]
  28. Hammond I. W., Devereux R. B., Alderman M. H., Laragh J. H. Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults. J Am Coll Cardiol. 1988 Oct;12(4):996–1004. doi: 10.1016/0735-1097(88)90467-6. [DOI] [PubMed] [Google Scholar]
  29. Hargreaves M., Morgan T. O., Snow R., Guerin M. Exercise tolerance in the heat on low and normal salt intakes. Clin Sci (Lond) 1989 May;76(5):553–557. doi: 10.1042/cs0760553. [DOI] [PubMed] [Google Scholar]
  30. Hollenberg N. K., Meggs L. G., Williams G. H., Katz J., Garnic J. D., Harrington D. P. Sodium intake and renal responses to captopril in normal man and in essential hypertension. Kidney Int. 1981 Aug;20(2):240–245. doi: 10.1038/ki.1981.126. [DOI] [PubMed] [Google Scholar]
  31. Joffres M. R., Hamet P., Rabkin S. W., Gelskey D., Hogan K., Fodor G. Prevalence, control and awareness of high blood pressure among Canadian adults. Canadian Heart Health Surveys Research Group. CMAJ. 1992 Jun 1;146(11):1997–2005. [PMC free article] [PubMed] [Google Scholar]
  32. Jula A. M., Karanko H. M. Effects on left ventricular hypertrophy of long-term nonpharmacological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation. 1994 Mar;89(3):1023–1031. doi: 10.1161/01.cir.89.3.1023. [DOI] [PubMed] [Google Scholar]
  33. Jula A., Rönnemaa T., Rastas M., Karvetti R. L., Mäki J. Long-term nopharmacological treatment for mild to moderate hypertension. J Intern Med. 1990 Jun;227(6):413–421. doi: 10.1111/j.1365-2796.1990.tb00180.x. [DOI] [PubMed] [Google Scholar]
  34. Koopman H., Spreeuwenberg C., Westerman R. F., Donker A. J. Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (2). Beyond three months. J Hum Hypertens. 1990 Aug;4(4):372–374. [PubMed] [Google Scholar]
  35. Kristinsson A., Hardarson T., Palsson K., Petursson M. K., Snorrason S. P., Thorgeirsson G. Additive effects of moderate dietary salt reduction and captopril in hypertension. Acta Med Scand. 1988;223(2):133–137. doi: 10.1111/j.0954-6820.1988.tb15777.x. [DOI] [PubMed] [Google Scholar]
  36. Kumanyika S. K., Hebert P. R., Cutler J. A., Lasser V. I., Sugars C. P., Steffen-Batey L., Brewer A. A., Cameron M., Shepek L. D., Cook N. R. Feasibility and efficacy of sodium reduction in the Trials of Hypertension Prevention, phase I. Trials of Hypertension Prevention Collaborative Research Group. Hypertension. 1993 Oct;22(4):502–512. doi: 10.1161/01.hyp.22.4.502. [DOI] [PubMed] [Google Scholar]
  37. Kurtz T. W., Al-Bander H. A., Morris R. C., Jr "Salt-sensitive" essential hypertension in men. Is the sodium ion alone important? N Engl J Med. 1987 Oct 22;317(17):1043–1048. doi: 10.1056/NEJM198710223171702. [DOI] [PubMed] [Google Scholar]
  38. Lawton W. J., Sinkey C. A., Fitz A. E., Mark A. L. Dietary salt produces abnormal renal vasoconstrictor responses to upright posture in borderline hypertensive subjects. Hypertension. 1988 Jun;11(6 Pt 1):529–536. doi: 10.1161/01.hyp.11.6.529. [DOI] [PubMed] [Google Scholar]
  39. Liebson P. R., Grandits G., Prineas R., Dianzumba S., Flack J. M., Cutler J. A., Grimm R., Stamler J. Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS). Circulation. 1993 Feb;87(2):476–486. doi: 10.1161/01.cir.87.2.476. [DOI] [PubMed] [Google Scholar]
  40. Logan A. G. Sodium manipulation in the management of hypertension. The view against its general use. Can J Physiol Pharmacol. 1986 Jun;64(6):793–802. doi: 10.1139/y86-136. [DOI] [PubMed] [Google Scholar]
  41. MacGregor G. A., Cappuccio F. P., Markandu N. D. Sodium intake, high blood pressure, and calcium channel blockers. Am J Med. 1987 Mar 30;82(3B):16–22. doi: 10.1016/0002-9343(87)90206-3. [DOI] [PubMed] [Google Scholar]
  42. MacGregor G. A., Markandu N. D., Best F. E., Elder D. M., Cam J. M., Sagnella G. A., Squires M. Double-blind randomised crossover trial of moderate sodium restriction in essential hypertension. Lancet. 1982 Feb 13;1(8268):351–355. doi: 10.1016/s0140-6736(82)91389-7. [DOI] [PubMed] [Google Scholar]
  43. MacGregor G. A., Markandu N. D., Sagnella G. A., Singer D. R., Cappuccio F. P. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989 Nov 25;2(8674):1244–1247. doi: 10.1016/s0140-6736(89)91852-7. [DOI] [PubMed] [Google Scholar]
  44. MacGregor G. A., Markandu N. D., Singer D. R., Cappuccio F. P., Shore A. C., Sagnella G. A. Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study. Br Med J (Clin Res Ed) 1987 Feb 28;294(6571):531–534. doi: 10.1136/bmj.294.6571.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Mark A. L., Lawton W. J., Abboud F. M., Fitz A. E., Connor W. E., Heistad D. D. Effects of high and low sodium intake on arterial pressure and forearm vasular resistance in borderline hypertension. A preliminary report. Circ Res. 1975 Jun;36(6 Suppl 1):194–198. doi: 10.1161/01.res.36.6.194. [DOI] [PubMed] [Google Scholar]
  46. Mascioli S., Grimm R., Jr, Launer C., Svendsen K., Flack J., Gonzalez N., Elmer P., Neaton J. Sodium chloride raises blood pressure in normotensive subjects. The study of sodium and blood pressure. Hypertension. 1991 Jan;17(1 Suppl):I21–I26. doi: 10.1161/01.hyp.17.1_suppl.i21. [DOI] [PubMed] [Google Scholar]
  47. Midgley J. P., Matthew A. G., Greenwood C. M., Logan A. G. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 1996 May 22;275(20):1590–1597. doi: 10.1001/jama.1996.03530440070039. [DOI] [PubMed] [Google Scholar]
  48. Miller J. Z., Weinberger M. H., Daugherty S. A., Fineberg N. S., Christian J. C., Grim C. E. Blood pressure response to dietary sodium restriction in healthy normotensive children. Am J Clin Nutr. 1988 Jan;47(1):113–119. doi: 10.1093/ajcn/47.1.113. [DOI] [PubMed] [Google Scholar]
  49. Morgan T., Adam W., Gillies A., Wilson M., Morgan G., Carney S. Hypertension treated by salt restriction. Lancet. 1978 Feb 4;1(8058):227–230. doi: 10.1016/s0140-6736(78)90479-8. [DOI] [PubMed] [Google Scholar]
  50. Morgan T., Anderson A. Interaction in hypertensive man between sodium intake, converting enzyme inhibitor (enalapril), plasma renin and blood pressure control. J Hum Hypertens. 1988 Mar;1(4):311–315. [PubMed] [Google Scholar]
  51. Morgan T., Anderson A. Interaction of slow-channel calcium blocking drugs with sodium restriction, diuretics and angiotensin converting enzyme inhibitors. J Hypertens Suppl. 1988 Dec;6(4):S652–S654. doi: 10.1097/00004872-198812040-00205. [DOI] [PubMed] [Google Scholar]
  52. Morgan T., Anderson A. Sodium restriction can delay the return of hypertension in patients previously well-controlled on drug therapy. Can J Physiol Pharmacol. 1987 Aug;65(8):1752–1755. doi: 10.1139/y87-274. [DOI] [PubMed] [Google Scholar]
  53. Muntzel M., Drüeke T. A comprehensive review of the salt and blood pressure relationship. Am J Hypertens. 1992 Apr;5(4 Pt 1):1S–42S. doi: 10.1093/ajh/5.4s.1s. [DOI] [PubMed] [Google Scholar]
  54. Myers J. B. Reduced sodium chloride intake normalises blood pressure distribution. J Hum Hypertens. 1989 Apr;3(2):97–104. [PubMed] [Google Scholar]
  55. Myers J., Morgan T. The effect of sodium intake on the blood pressure related to age and sex. Clin Exp Hypertens A. 1983;5(1):99–118. doi: 10.3109/10641968309048813. [DOI] [PubMed] [Google Scholar]
  56. Nestel P. J., Clifton P. M., Noakes M., McArthur R., Howe P. R. Enhanced blood pressure response to dietary salt in elderly women, especially those with small waist: hip ratio. J Hypertens. 1993 Dec;11(12):1387–1394. doi: 10.1097/00004872-199312000-00011. [DOI] [PubMed] [Google Scholar]
  57. Overlack A., Ruppert M., Kolloch R., Kraft K., Stumpe K. O. Age is a major determinant of the divergent blood pressure responses to varying salt intake in essential hypertension. Am J Hypertens. 1995 Aug;8(8):829–836. doi: 10.1016/0895-7061(95)00213-9. [DOI] [PubMed] [Google Scholar]
  58. Puska P., Iacono J. M., Nissinen A., Korhonen H. J., Vartianinen E., Pietinen P., Dougherty R., Leino U., Mutanen M., Moisio S. Controlled, randomised trial of the effect of dietary fat on blood pressure. Lancet. 1983 Jan 1;1(8314-5):1–5. doi: 10.1016/s0140-6736(83)91556-8. [DOI] [PubMed] [Google Scholar]
  59. Richards A. M., Nicholls M. G., Espiner E. A., Ikram H., Maslowski A. H., Hamilton E. J., Wells J. E. Blood-pressure response to moderate sodium restriction and to potassium supplementation in mild essential hypertension. Lancet. 1984 Apr 7;1(8380):757–761. doi: 10.1016/s0140-6736(84)91276-5. [DOI] [PubMed] [Google Scholar]
  60. Richards A. M., Tonolo G., Cleland J. G., Leckie B. J., McIntyre G. D., Ingram M., Dargie H. J., Ball S. G., Robertson J. I. Plasma atrial natriuretic peptide: responses to modest and severe sodium restriction. J Hypertens Suppl. 1986 Dec;4(6):S559–S563. [PubMed] [Google Scholar]
  61. Ruppert M., Overlack A., Kolloch R., Kraft K., Göbel B., Stumpe K. O. Neurohormonal and metabolic effects of severe and moderate salt restriction in non-obese normotensive adults. J Hypertens. 1993 Jul;11(7):743–749. doi: 10.1097/00004872-199307000-00010. [DOI] [PubMed] [Google Scholar]
  62. Schmid M., Mann J. F., Stein G., Herter M., Nussberger J., Klingbeil A., Ritz E. Natriuresis-pressure relationship in polycystic kidney disease. J Hypertens. 1990 Mar;8(3):277–283. [PubMed] [Google Scholar]
  63. Schmieder R. E., Messerli F. H., Garavaglia G. E., Nunez B. D. Dietary salt intake. A determinant of cardiac involvement in essential hypertension. Circulation. 1988 Oct;78(4):951–956. doi: 10.1161/01.cir.78.4.951. [DOI] [PubMed] [Google Scholar]
  64. Sharma A. M., Arntz H. R., Kribben A., Schattenfroh S., Distler A. Dietary sodium restriction: adverse effect on plasma lipids. Klin Wochenschr. 1990 Jul 5;68(13):664–668. doi: 10.1007/BF01667013. [DOI] [PubMed] [Google Scholar]
  65. Sharma A. M., Ruland K., Spies K. P., Distler A. Salt sensitivity in young normotensive subjects is associated with a hyperinsulinemic response to oral glucose. J Hypertens. 1991 Apr;9(4):329–335. doi: 10.1097/00004872-199104000-00004. [DOI] [PubMed] [Google Scholar]
  66. Sharma A. M., Schorr U., Distler A. Insulin resistance in young salt-sensitive normotensive subjects. Hypertension. 1993 Mar;21(3):273–279. doi: 10.1161/01.hyp.21.3.273. [DOI] [PubMed] [Google Scholar]
  67. Silman A. J., Locke C., Mitchell P., Humpherson P. Evaluation of the effectiveness of a low sodium diet in the treatment of mild to moderate hypertension. Lancet. 1983 May 28;1(8335):1179–1182. doi: 10.1016/s0140-6736(83)92463-7. [DOI] [PubMed] [Google Scholar]
  68. Skrabal F., Auböck J., Hörtnagl H. Low sodium/high potassium diet for prevention of hypertension: probable mechanisms of action. Lancet. 1981 Oct 24;2(8252):895–900. doi: 10.1016/s0140-6736(81)91392-1. [DOI] [PubMed] [Google Scholar]
  69. Skrabal F., Herholz H., Neumayr M., Hamberger L., Ledochowski M., Sporer H., Hörtnagl H., Schwarz S., Schönitzer D. Salt sensitivity in humans is linked to enhanced sympathetic responsiveness and to enhanced proximal tubular reabsorption. Hypertension. 1984 Mar-Apr;6(2 Pt 1):152–158. [PubMed] [Google Scholar]
  70. Stamler J. Dietary salt and blood pressure. Ann N Y Acad Sci. 1993 Mar 15;676:122–156. doi: 10.1111/j.1749-6632.1993.tb38730.x. [DOI] [PubMed] [Google Scholar]
  71. Stamler R., Stamler J., Gosch F. C., Civinelli J., Fishman J., McKeever P., McDonald A., Dyer A. R. Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial. JAMA. 1989 Oct 6;262(13):1801–1807. [PubMed] [Google Scholar]
  72. Suppa G., Pollavini G., Alberti D., Savonitto S. Effects of a low-sodium high-potassium salt in hypertensive patients treated with metoprolol: a multicentre study. J Hypertens. 1988 Oct;6(10):787–790. [PubMed] [Google Scholar]
  73. Teow B. H., Di Nicolantonio R., Morgan T. O. Sodium chloride preference and recognition threshold in normotensive subjects on high and low salt diet. Clin Exp Hypertens A. 1985;7(12):1681–1695. doi: 10.3109/10641968509073618. [DOI] [PubMed] [Google Scholar]
  74. Watt G. C., Edwards C., Hart J. T., Hart M., Walton P., Foy C. J. Dietary sodium restriction for mild hypertension in general practice. Br Med J (Clin Res Ed) 1983 Feb 5;286(6363):432–436. doi: 10.1136/bmj.286.6363.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Watt G. C., Foy C. J., Hart J. T., Bingham G., Edwards C., Hart M., Thomas E., Walton P. Dietary sodium and arterial blood pressure: evidence against genetic susceptibility. Br Med J (Clin Res Ed) 1985 Nov 30;291(6508):1525–1528. doi: 10.1136/bmj.291.6508.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Zoccali C., Mallamaci F., Leonardis D., Romeo M. Randomly allocated crossover study of various levels of sodium intake in patients with mild hypertension. J Hypertens Suppl. 1993 Dec;11(5):S326–S327. [PubMed] [Google Scholar]
  77. el Ashry A., Heagerty A. M., Alton S. M., Bing R. F., Swales J. D., Thurston H. Effects of manipulation of sodium balance on erythrocyte sodium transport. J Hum Hypertens. 1987 Sep;1(2):105–111. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES