Jie Yu1,2, Sudhir Raj Thout3, Qiang Li1, Maoyi Tian1,4, Matti Marklund1,5, Clare Arnott1,6,7, Mark D Huffman1,8, Devarsetty Praveen3, Claire Johnson1, Liping Huang1, Simone Pettigrew1, Bruce Neal1,9, Jason H Y Wu1. 1. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 2. Department of Cardiology, Peking University Third Hospital, Beijing, China. 3. The George Institute for Global Health India, Punjagutta, Hyderabad, India. 4. The George Institute for Global Health at Peking University Health Science Centre, Beijing, China. 5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 6. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. 7. Sydney Medical School, University of Sydney, Sydney, Australia. 8. Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 9. Imperial College London, London, United Kingdom.
Abstract
BACKGROUND: High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensive patients. OBJECTIVES: Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensive patients. METHODS: We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided. RESULTS:A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly. CONCLUSION: The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensive patients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659.
RCT Entities:
BACKGROUND: High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensivepatients. OBJECTIVES: Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensivepatients. METHODS: We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided. RESULTS: A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly. CONCLUSION: The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensivepatients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659.
Authors: Martin Gritter; Rosa D Wouda; Stanley M H Yeung; Michiel L A Wieërs; Frank Geurts; Maria A J de Ridder; Christian R B Ramakers; Liffert Vogt; Martin H de Borst; Joris I Rotmans; Ewout J Hoorn Journal: J Am Soc Nephrol Date: 2022-05-24 Impact factor: 14.978
Authors: Erik Cateriano-Arévalo; Lorena Saavedra-Garcia; Vilarmina Ponce-Lucero; J Jaime Miranda Journal: Int J Environ Res Public Health Date: 2021-12-16 Impact factor: 3.390