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Salt and blood pressure in children: reply to commentary by Alderman

Journal of Human Hypertension volume 22, pages 71–72 (2008)Cite this article

We are grateful to Dr Alderman for his commentary1 on our paper.2 However, we respectfully disagree with several aspects of his article.

In relation to the evidence on salt and blood pressure (BP) in children, he does not mention the large body of evidence that BP tracks,3, 4 and any reduction in BP in childhood is likely to lead to much larger changes subsequently in adulthood. It would also have been worth highlighting a recent meta-analysis of salt reduction trials in children, where there was a significant fall in BP with a modest reduction in salt intake,5 and in the commentary, there was only one quote of a paper on the relation between salt intake and BP in children, giving a selected view of the literature. Of importance, the magnitude of the quantitative association between salt intake and BP observed in our paper,2 involving a large number of children on their usual diet, is very close to that found in the meta-analysis where salt intake was reduced.5 These consistent findings provide very strong support for a reduction in salt intake in children.

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References

  1. Alderman MH . Salt and blood pressure in children. J Hum Hypertens; e-pub ahead of print: 6 September 2007; doi:10.1038/sj.jhh.1002269.

    Article  Google Scholar 

  2. He FJ, Marrero NM, MacGregor GA . Salt and blood pressure in children and adolescents. J Hum Hypertens; e-pub ahead of print: 6 September 2007; doi:10.1038/sj.jhh.1002268.

    Article  Google Scholar 

  3. Lauer RM, Clarke WR . Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics 1989; 84: 633–641.

    CAS  Google Scholar 

  4. Nelson MJ, Ragland DR, Syme SL . Longitudinal prediction of adult blood pressure from juvenile blood pressure levels. Am J Epidemiol 1992; 136: 633–645.

    Article  CAS  Google Scholar 

  5. He FJ, MacGregor GA . Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension 2006; 48: 861–869.

    Article  CAS  Google Scholar 

  6. Graudal NA, Galloe AM, Garred P . Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA 1998; 279: 1383–1391.

    Article  CAS  Google Scholar 

  7. Hooper L, Bartlett C, Davey Smith G, Ebrahim S . Advice to reduce dietary salt for prevention of cardiovascular disease. Cochrane Database Syst Rev 2004 issue 1, art. no. CD003656. doi: 10.1002/14651858.CD003656.pub2.

  8. James WP, Ralph A, Sanchez-Castillo CP . The dominance of salt in manufactured food in the sodium intake of affluent societies. Lancet 1987; 1: 426–429.

    Article  CAS  Google Scholar 

  9. He FJ, MacGregor GA . Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004 issue 1, art. no. CD004937. doi: 10.1002/14651858.CD004937 (updated in 2005).

  10. He FJ, MacGregor GA . Salt intake and sympathetic activity. Circulation 2003; 107: e108.

    Article  Google Scholar 

  11. de Wardener HE . Salt reduction and cardiovascular risk: the anatomy of a myth. J Hum Hypertens 1999; 13: 1–4.

    Article  CAS  Google Scholar 

  12. Beckmann SL, Os I, Kjeldsen SE, Eide IK, Westheim AS, Hjermann I . Effect of dietary counselling on blood pressure and arterial plasma catecholamines in primary hypertension. Am J Hypertens 1995; 8: 704–711.

    Article  CAS  Google Scholar 

  13. Meland E, Laerum E, Aakvaag A, Ulvik RJ, Hostmark AT . Salt restriction: effects on lipids and insulin production in hypertensive patients. Scand J Clin Lab Invest 1997; 57: 501–505.

    Article  CAS  Google Scholar 

  14. Singer DR, Markandu ND, Cappuccio FP, Miller MA, Sagnella GA, MacGregor GA . Reduction of salt intake during converting enzyme inhibitor treatment compared with addition of a thiazide. Hypertension 1995; 25: 1042–1044.

    Article  CAS  Google Scholar 

  15. He FJ, MacGregor GA . Response to salt intake in children: increasing concerns? (letter). Hypertension 2007; 49: e11.

    Article  Google Scholar 

  16. Schreuder MF, Bokenkamp A, van Wijk JA . Salt intake in children: increasing concerns? (letter). Hypertension 2007; 49: e10.

    Article  Google Scholar 

  17. Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 2007; 334: 885.

    Article  Google Scholar 

  18. Food Standards Agency. Dietary sodium levels surveys, 20 March 2007, http://www.food.gov.uk/science/dietarysurveys/urinary (accessed 8 June 2007).

  19. He FJ, Macgregor GA . Salt, blood pressure and cardiovascular disease. Curr Opin Cardiol 2007; 22: 298–305.

    Article  Google Scholar 

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  1. Department of Cardiac and Vascular Sciences, Blood Pressure Unit, St George's University of London, London, UK

    F J He & G A MacGregor

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  1. F J He
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  2. G A MacGregor
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Correspondence to G A MacGregor.

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He, F., MacGregor, G. Salt and blood pressure in children: reply to commentary by Alderman. J Hum Hypertens 22, 71–72 (2008). https://doi.org/10.1038/sj.jhh.1002280

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