Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Long-term effects of salt substitution on blood pressure in a rural North Chinese population

Journal of Human Hypertension volume 27, pages 427–433 (2013)Cite this article

Subjects

Abstract

Dietary sodium and potassium intake can influence blood pressure. The effects of salt substitution on patients with hypertension and normotensive family member controls, however, have not been evaluated in a rural Chinese population. The objective of this study, accordingly, was to assess the long-term effects of salt substitution on blood pressure. We conducted a double-blind, randomized controlled trial among 200 families in rural China to establish the 2-year effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with normal salt (100% sodium chloride) on blood pressure. Of the 462 individuals in the trial, 372 completed the study (81%). For normotensive subjects, the mean overall difference in systolic and diastolic blood pressure between the two groups at the 24-month follow-up was 2 mm Hg (95% confidence interval (CI) 0–4 mm Hg, P<0.05) and 2 mm Hg (95% CI 1–3 mm Hg, P<0.05), respectively. For subjects with hypertension, the mean overall decrease in systolic blood pressure showed a 4-mm Hg (95% CI 2–6 mm Hg, P<0.05) decrease between the two groups. Diastolic blood pressure was not affected by salt use in the hypertensive group. Salt substitution lowers systolic blood pressure in hypertensive patients and lowers both systolic and diastolic blood pressure in normotensive controls. Salt substitution, therefore, may be an effective adjuvant therapy for hypertensive patients and the potential efficacy in preventing hypertension in normotensive individuals.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Organization WH. World Health Report 2002: Reducing Risks, Promoting Healthy Life. World Health Organization: Geneva, Switzerland, World Wide Web URL 2002. http://www.who int/whr/2002/en 2002.

  2. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997; 336: 1117–1124.

    Article  CAS  Google Scholar 

  3. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ 1988; 297: 319–328.

    Article  Google Scholar 

  4. Poulter NR, Khaw KT, Hopwood BE, Mugambi M, Peart WS, Rose G et al. The Kenyan Luo migration study: observations on the initiation of a rise in blood pressure. BMJ 1990; 300: 967–972.

    Article  CAS  Google Scholar 

  5. Forte JG, Miguel JM, Miguel MJ, de Padua F, Rose G . Salt and blood pressure: a community trial. J Hum Hypertens. 1989; 3: 179–184.

    CAS  PubMed  Google Scholar 

  6. He FJ, MacGregor GA . Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002; 16: 761–770.

    Article  CAS  Google Scholar 

  7. Denton D, Weisinger R, Mundy NI, Wickings EJ, Dixson A, Moisson P et al. The effect of increased salt intake on blood pressure of chimpanzees. Nat Med. 1995; 1: 1009–1016.

    Article  CAS  Google Scholar 

  8. Lifton RP . Molecular genetics of human blood pressure variation. Science 1996; 272: 676–680.

    Article  CAS  Google Scholar 

  9. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001; 344: 3–10.

    Article  CAS  Google Scholar 

  10. Grobbee DE . Electrolytes and hypertension: results from recent studies. Am J Med Sci. 1994; 307 (Suppl 1): S17–S20.

    PubMed  Google Scholar 

  11. Khaw KT, Thom S . Randomised double-blind cross-over trial of potassium on blood-pressure in normal subjects. Lancet 1982; 2 (8308): 1127–1129.

    Article  CAS  Google Scholar 

  12. He FJ, MacGregor GA . Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004; (3): CD004937.

  13. Dyer AR, Elliott P, Shipley M . Urinary electrolyte excretion in 24 h and blood pressure in the INTERSALT Study. II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. The INTERSALT Cooperative Research Group. Am J Epidemiol. 1994; 139: 940–951.

    Article  CAS  Google Scholar 

  14. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997; 277: 1624–1632.

    Article  CAS  Google Scholar 

  15. Dahlmann A, Pradervand S, Hummler E, Rossier BC, Frindt G, Palmer LG . Mineralocorticoid regulation of epithelial Na+ channels is maintained in a mouse model of Liddle’s syndrome. Am J Physiol Renal Physiol. 2003; 285: F310–F318.

    Article  CAS  Google Scholar 

  16. Geleijnse JM, Witteman JC, Bak AA, den Breeijen JH, Grobbee DE . Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. BMJ 1994; 309: 436–440.

    Article  CAS  Google Scholar 

  17. Little P, Kelly J, Barnett J, Dorward M, Margetts B, Warm D . Randomised controlled factorial trial of dietary advice for patients with a single high blood pressure reading in primary care. BMJ 2004; 328: 1054.

    Article  Google Scholar 

  18. China Salt Substitute Study Collaborative Group. Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial. J Hypertens. 2007; 25: 2011–2018.

    Article  Google Scholar 

  19. Shi JP, Wang HL, Li H, Dong W, Fu LY, Qi GX et al. The epidemiological survey of prevalence rate of hypertension in the countryside of Zhangwu county, Liaoning province. Zhonghua Liu Xing Bing Xue Za Zhi. 2003; 24: 547–550.

    PubMed  Google Scholar 

  20. Karppanen H, Tanskanen A, Tuomilehto J, Puska P, Vuori J, Jantti V et al. Safety and effects of potassium- and magnesium-containing low sodium salt mixtures. J Cardiovasc Pharmacol. 1984; 6 (Suppl 1): S236–S243.

    Article  Google Scholar 

  21. Fu L, Zhao Y, Wu X, Liu H, Shi J, Lu J et al. CYP7A1 genotypes and haplotypes associated with hypertension in an obese Han Chinese population. Hypertens Res. 2011; 34: 722–727.

    Article  CAS  Google Scholar 

  22. MacGregor GA, Markandu ND, Sagnella GA, Singer DR, Cappuccio FP . Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet 1989; 2: 1244–1247.

    Article  CAS  Google Scholar 

  23. He FJ, MacGregor GA . A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009; 23: 363–384.

    Article  CAS  Google Scholar 

  24. Cappuccio FP, MacGregor GA . Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991; 9: 465–473.

    Article  CAS  Google Scholar 

  25. He FJ, MacGregor GA . Potassium intake and blood pressure. Am J Hypertens. 1999; 12: 849–851.

    Article  CAS  Google Scholar 

  26. He FJ, MacGregor GA . Fortnightly review: Beneficial effects of potassium. BMJ 2001; 323: 497–501.

    Article  CAS  Google Scholar 

  27. Mizushima S, Cappuccio FP, Nichols R, Elliott P . Dietary magnesium intake and blood pressure: a qualitative overview of the observational studies. J Hum Hypertens. 1998; 12: 447–453.

    Article  CAS  Google Scholar 

  28. Laurant P, Touyz RM . Physiological and pathophysiological role of magnesium in the cardiovascular system: implications in hypertension. J Hypertens. 2000; 18: 1177–1191.

    Article  CAS  Google Scholar 

  29. Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ . The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens. 2002; 15: 691–696.

    Article  CAS  Google Scholar 

  30. Touyz RM . Role of magnesium in the pathogenesis of hypertension. Mol Aspects Med. 2003; 24: 107–136.

    Article  CAS  Google Scholar 

  31. Song Y, Sesso HD, Manson JE, Cook NR, Buring JE, Liu S . Dietary magnesium intake and risk of incident hypertension among middle-aged and older US women in a 10-year follow-up study. Am J Cardiol. 2006; 98: 1616–1621.

    Article  CAS  Google Scholar 

  32. Tian HG, Guo ZY, Hu G, Yu SJ, Sun W, Pietinen P et al. Changes in sodium intake and blood pressure in a community-based intervention project in China. J Hum Hypertens. 1995; 9: 959–968.

    CAS  PubMed  Google Scholar 

  33. Cutler JA, Follmann D, Allender PS . Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997; 65: 643S–651S.

    Article  CAS  Google Scholar 

  34. Rodgers A, Lawes C, MacMahon S . Reducing the global burden of blood pressure-related disease. J Hypertens. 2000; 18: S3–S6.

    Article  CAS  Google Scholar 

  35. China Ministry of Health, China Ministry of Science and Technology, and China State Bureau of Statistics. The Nutrition and Health Status of the Chinese People. In: Material for the press conference of the State Council Information Office, October 2004 Ministry of Health, China Ministry of Science and Technology, and China State Bureau of Statistics: Beijing: China, 2004.

  36. He J, Klag MJ, Wu Z, Whelton PK . Stroke in the People’s Republic of China. Geographic variations in incidence and risk factors. Stroke 1995; 26: 2222–2227.

    Article  CAS  Google Scholar 

  37. Tumbull F and Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blood pressure lowering regimens on major cardiovascular events: second cycle of prospectively designed overviews. Lancet 2003; 362: 1527–1535.

    Article  Google Scholar 

  38. Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H et al. Blood pressure and cardiovascular diseases in the Asia-Pacific region. J Hypertens. 2003; 21: 707–716.

    Article  CAS  Google Scholar 

  39. Bazzano LA, He J, Ogden LG, Vupputuri S, Loria C, Myers L et al. Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study. Stroke 2001; 32: 1473–1480.

    Article  CAS  Google Scholar 

  40. Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD . Dietary salt intake. a determinant of cardiac involvement in essential hypertension. Circulation 1988; 78: 951–956.

    Article  CAS  Google Scholar 

  41. Fujiwara T, Kawamura M, Nakajima J, Adachi T, Hiramori K . Seasonal differences in diurnal blood pressure of hypertensive patients living in a stable environmental temperature. J Hypertens. 1995; 13: 1747–1752.

    Article  CAS  Google Scholar 

  42. Law MR, Frost CD, Wald NJ . By how much does dietary salt reduction lower blood pressure? III. Analysis of data from trials of salt reduction. BMJ 1991; 302: 819–824.

    Article  CAS  Google Scholar 

  43. 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 

  44. Turnbull F . Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527–1535.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by the grants from Program of the National Natural Science Foundation of China (30800944 and 30671796).

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, China

    B Zhou, H-L Wang, X-M Wu, L-Y Fu & J-P Shi

  2. Cardiovascular Institute of China Medical University, China Medical University, Shenyang, China

    B Zhou, H-L Wang, X-M Wu, L-Y Fu & J-P Shi

  3. Department of Precaution, Health Bureau of Zhangwu County, Fuxin, China

    W-L Wang

Authors
  1. B Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H-L Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W-L Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. X-M Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L-Y Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J-P Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J-P Shi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, B., Wang, HL., Wang, WL. et al. Long-term effects of salt substitution on blood pressure in a rural North Chinese population. J Hum Hypertens 27, 427–433 (2013). https://doi.org/10.1038/jhh.2012.63

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2012.63

Keywords

This article is cited by

Search

Advanced search

Quick links