title: Nutrition in cardiovascular disease: salt in hypertension and heart failure.
abstract: There is much evidence for a causal relationship between salt intake and blood pressure (BP). The current salt intake in many countries is between 9 and 12 g/day. A reduction in salt intake to the recommended level of 5-6 g/day lowers BP in both hypertensive and normotensive individuals. A further reduction to 3-4 g/day has a much greater effect. Prospective studies and outcome trials have demonstrated that a lower salt intake is associated with a decreased risk of cardiovascular disease. Increasing evidence also suggests that a high salt intake is directly related to left ventricular hypertrophy (LVH) independent of BP. Both raised BP and LVH are important risk factors for heart failure. It is therefore possible that a lower salt intake could prevent the development of heart failure. In patients who already have heart failure, a high salt intake aggravates the retention of salt and water, thereby exacerbating heart failure symptoms and progression of the disease. A lower salt intake plays an important role in the management of heart failure. Despite this, currently there is no clear evidence on how far salt intake should be reduced in heart failure. Our personal view is that these patients should reduce their salt intake to <5 g/day, i.e. the maximum intake recommended by the World Health Organisation for all adults. If salt intake is successfully reduced, there may well be a need for a reduction in diuretic dosage.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. f.he@qmul.ac.uk
authors.forename: Feng J
authors.initials: FJ
authors.lastname: He
authors.forename: Michel
authors.initials: M
authors.lastname: Burnier
authors.forename: Graham A
authors.initials: GA
authors.lastname: Macgregor
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D003362:Cost-Benefit Analysis; D004032:Diet / Q000009:adverse effects; D004039:Diet, Sodium-Restricted / Q000379:methods; D004305:Dose-Response Relationship, Drug; D018565:Food-Drug Interactions; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D008019:Life Style; D009765:Obesity / Q000517:prevention & control; D012307:Risk Factors; D017673:Sodium Chloride, Dietary / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D017673:Sodium Chloride, Dietary