| Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. | |
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MedLine Citation:
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PMID: 21540421 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Extrapolations from observational studies and short-term intervention trials suggest that population-wide moderation of salt intake might reduce cardiovascular events. OBJECTIVE: To assess whether 24-hour urinary sodium excretion predicts blood pressure (BP) and health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Prospective population study, involving 3681 participants without cardiovascular disease (CVD) who are members of families that were randomly enrolled in the Flemish Study on Genes, Environment, and Health Outcomes (1985-2004) or in the European Project on Genes in Hypertension (1999-2001). Of 3681 participants without CVD, 2096 were normotensive at baseline and 1499 had BP and sodium excretion measured at baseline and last follow-up (2005-2008). MAIN OUTCOME MEASURES: Incidence of mortality and morbidity and association between changes in BP and sodium excretion. Multivariable-adjusted hazard ratios (HRs) express the risk in tertiles of sodium excretion relative to average risk in the whole study population. RESULTS: Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion, from 50 deaths in the low (mean, 107 mmol), 24 in the medium (mean, 168 mmol), and 10 in the high excretion group (mean, 260 mmol; P < .001), resulting in respective death rates of 4.1% (95% confidence interval [CI], 3.5%-4.7%), 1.9% (95% CI, 1.5%-2.3%), and 0.8% (95% CI, 0.5%-1.1%). In multivariable-adjusted analyses, this inverse association retained significance (P = .02): the HR in the low tertile was 1.56 (95% CI, 1.02-2.36; P = .04). Baseline sodium excretion predicted neither total mortality (P = .10) nor fatal combined with nonfatal CVD events (P = .55). Among 2096 participants followed up for 6.5 years, the risk of hypertension did not increase across increasing tertiles (P = .93). Incident hypertension was 187 (27.0%; HR, 1.00; 95% CI, 0.87-1.16) in the low, 190 (26.6%; HR, 1.02; 95% CI, 0.89-1.16) in the medium, and 175 (25.4%; HR, 0.98; 95% CI, 0.86-1.12) in the high sodium excretion group. In 1499 participants followed up for 6.1 years, systolic blood pressure increased by 0.37 mm Hg per year (P < .001), whereas sodium excretion did not change (-0.45 mmol per year, P = .15). However, in multivariable-adjusted analyses, a 100-mmol increase in sodium excretion was associated with 1.71 mm Hg increase in systolic blood pressure (P.<001) but no change in diastolic BP. CONCLUSIONS: In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality. |
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Authors:
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Katarzyna Stolarz-Skrzypek; Tatiana Kuznetsova; Lutgarde Thijs; Valérie Tikhonoff; Jitka Seidlerová; Tom Richart; Yu Jin; Agnieszka Olszanecka; Sofia Malyutina; Edoardo Casiglia; Jan Filipovský; Kalina Kawecka-Jaszcz; Yuri Nikitin; Jan A Staessen; |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 305 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-04 Completed Date: 2011-05-09 Revised Date: 2012-02-08 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 1777-85 Citation Subset: AIM; IM |
Affiliation:
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Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Belgium / epidemiology Blood Pressure Cardiovascular Diseases / mortality* Diet, Sodium-Restricted* Female Humans Hypertension / epidemiology* Incidence Male Middle Aged Mortality / trends Predictive Value of Tests Prospective Studies Sodium / metabolism, urine* Sodium, Dietary / metabolism Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Sodium, Dietary; 7440-23-5/Sodium |
| Comments/Corrections | |
Comment In:
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Kardiol Pol. 2011;69(12):1314-5
[PMID:
22219120
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JAMA. 2011 Sep 14;306(10):1085; author reply 1086-7 [PMID: 21917576 ] JAMA. 2011 Sep 14;306(10):1083-4; author reply 1086-7 [PMID: 21917571 ] JAMA. 2011 Sep 14;306(10):1083; author reply 1086-7 [PMID: 21917572 ] JAMA. 2011 Sep 14;306(10):1084; author reply 1086-7 [PMID: 21917574 ] JAMA. 2011 Sep 14;306(10):1084-5; author reply 1086-7 [PMID: 21917573 ] JAMA. 2011 Sep 14;306(10):1085-6; author reply 1086-7 [PMID: 21917575 ] |
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