Lower 24-h urinary sodium excretion is associated with hypertension control: the 2010 Heart Follow-Up Study

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Among individuals with hypertension, controlling high blood pressure (BP) reduces the risk for cardiovascular events and death. Reducing dietary sodium can help achieve BP control. The study aim was to use a population-based sample utilizing the gold standard for urinary sodium to quantify the degree with which sodium was independently associated with BP control among individuals with hypertension. Participants included 1568 adults from the Heart Follow-Up Study, a New York City population-based representative study conducted in 2010. Participants collected urine for 24 h and had BP and other anthropometrics measured. Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or being on BP lowering medication. Sodium intake (mg/day) was measured from a single 24-h urine collection. Hypertension prevalence was 30.8%. Among those with hypertension, 64.6% were aware, 56.3% were treated, and 40.3% were controlled. Among those treated for hypertension, 73.0% were controlled. Mean sodium intake among those with hypertension was 3564 mg/day. From multivariable adjusted logistic regression models, each 500 mg decrease in 24-h urinary sodium excretion was associated with a 18% higher odds of hypertension control among those with hypertension (1.18, 95% CI: 1.07, 1.30). In New York City, approximately one in three people has hypertension with a majority uncontrolled. Sodium intake among those with hypertension was 55% greater than recommended upper limit of 2300 mg per day. Among individuals with hypertension, lower sodium intake was associated with hypertension control.

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  1. 1.

    Benjamin EJ, Blaha MJ, Chiuve SE, Cushamn M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–603.

  2. 2.

    Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med. 2010;38:600–9.

  3. 3.

    Kotchen TA. Establishing funding priorities for hypertension research: a modest proposal. Hypertension. 2017;70:893–6.

  4. 4.

    Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, et al. Potential U.S. population impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Circulation. 2018;137:109–18.

  5. 5.

    Grotto I, Huerta M, Sharabi Y. Hypertension and socioeconomic status. Curr Opin Cardiol. 2008;23:335–9.

  6. 6.

    Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372:1661–9.

  7. 7.

    Sorlie PD, Allison MA, Aviles-Santa ML, Cai J, Daviglus ML, Howard AG, et al. Prevalence of hypertension, awareness, treatment, and control in the Hispanic Community Health Study/Study of Latinos. Am J Hypertens. 2014;27:793–800.

  8. 8.

    Fei K, Rodriguez-Lopez JS, Ramos M, Islam N, Trinh-Shevrin C, Yi SS, et al. Racial and Ethnic subgroup disparities in hypertension prevalence, New York City Health and Nutrition Examination Survey, 2013-2014. Preventing Chronic Dis. 2017;14:E33.

  9. 9.

    Chobanian A, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. Seventh report of the joint national committee on prevention, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

  10. 10.

    Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63:878–85.

  11. 11.

    Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PL, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the premier clinical trial. JAMA. 2003;289:2083–93.

  12. 12.

    Appel L, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.

  13. 13.

    Appel L, Brands BW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension. a scientific statement from the American Heart Association. Hypertension. 2006;47:296–308.

  14. 14.

    Willett W. Commentary: dietary diaries versus food frequency questionnaires—a case of undigestible data. Int J Epidemiol. 2001;30:317–9.

  15. 15.

    Institute of Medicine (US). Committee on strategies to reduce sodium intake. In: Henney JE, Taylor CL, Boon CS, editors. Strategies to reduce sodium intake in the United States. Washington, DC: National Academies Press (US); 2010.

  16. 16.

    Sanderson M, Yi S, Bartley K, Quitoni K, Immervahr S, Curtis CJ, et al. The Community Health Survey, Heart Follow-Up Study: methodology report. New York City: Department of Health and Mental Hygiene; 2012.

  17. 17.

    New York City Department of Health and Mental Hygiene. Survey data on the health of New Yorkers. New York City Department of Health and Mental Hygiene; 2013. http://www.nyc.gov/html/doh/html/data/chs-methods.shtml. Accessed 13 Jun 2013.

  18. 18.

    New York City Department of Health and Mental Hygiene. The Community Health Survey Heart Follow-Up Study (HFUS) Clinical Protocol. New York City Department of Health and Mental Hygiene; 2010.

  19. 19.

    Ostchega Y, Nwankwo T, Sorlie PD, Wolz M, Zipf G. Assessing the validity of the Omron HEM-907XL oscillometric blood pressure measurement device in a National Survey environment. J Clin Hypertens. 2010;12:22–28.

  20. 20.

    National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39 2 Suppl 1:S1–266.

  21. 21.

    US Department of Health and Human Services. 2008 physical activity guidelines for Americans. US Department of Health and Human Services; 2008. http://www.health.gov/paguidelines/pdf/paguide.pdf. Accessed 21 Sep 2016.

  22. 22.

    Greenberg A. Diuretic complications. Am J Med Sci. 2000;319:10–24.

  23. 23.

    US Department of Agriculture. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: U.S Government Printing Office; 2015.

  24. 24.

    Gillespie CD, Hurvitz KA. Prevalence of hypertension and controlled hypertension - United States, 2007-2010. MMWR Suppl. 2013;62:144–8.

  25. 25.

    Hertz R, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension, prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–104.

  26. 26.

    Angell S, Garg RK, Gwynn C, Bash L, Thorpe LE, Frieden TR. Prevalence, awareness, treatment, and predictors of control of hypertension in New York City. Circ Cardiovas Qual Outcomes. 2008;1:46–53.

  27. 27.

    Gresia VWM, Li W, Jasek J, Sun Y, DiLonardo S, Chamany S. Premature Heart disease and stroke deaths among adults in New York City. Epi Data Brief. 2017;95:1–4.

  28. 28.

    Nguyen QC, Tabor JW, Entzel PP, Lau Y, Suchindran C, Hussey JM, et al. Discordance in national estimates of hypertension among young adults. Epidemiology. 2011;22:532–41.

  29. 29.

    Pletcher MJ, Vittinghoff E, Thanataveerat A, Bibbins-Domingo K, Moran AE. Young adult exposure to cardiovascular risk factors and risk of events later in life. Framingham Offspring Study. 2016;11:e0154288.

  30. 30.

    Zhang Y, Moran AE. Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999 to 2014. Hypertension. 2017;70:736–42.

  31. 31.

    Yoon SS, Burt V, Louis T, Carroll MD. Hypertension among adults in the United States, 2009-2010. NCHS data brief. 2012;107:1–8.

  32. 32.

    He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. Brit Med J. 2013;346:f1325.

  33. 33.

    Firestone MJ, Beasley JM, Kwon SC, Ahn J, Trinh-Shevrin C, Yi SS. Asian American dietary sources of sodium and salt behaviors compared with other racial/ethnic groups, NHANES, 2011-2012. Ethnicity Dis. 2017;27:241–8.

  34. 34.

    Bailey RL, Parker EA, Rhodes DG, Goldman JD, Clemens JC, Moshfegh AJ, et al. Estimating sodium and potassium intakes and their ratio in the American diet: data from the 2011-2012 NHANES. J Nutr. 2016. pii: jn221184. [Epub ahead of print].

  35. 35.

    Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary sodium and cardiovascular disease risk - measurement matters. N Engl J Med. 2016;375:580–6.

  36. 36.

    John KA, Cogswell ME, Campbell NR, Nowson CA, Legetic B, Hennis AJ, et al. Accuracy and usefulness of select methods for assessing complete collection of 24-hour urine: a systematic review. J Clin Hypertens. 2016;18:456–67.

  37. 37.

    Cogswell ME, Maalouf J, Elliott P, Loria CM, Patel S, Bowman BA. Use of urine biomarkers to assess sodium intake: challenges and opportunities. Annu Rev Nutr. 2015;35:349–87.

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Correspondence to Tali Elfassy.

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Elfassy, T., Chamany, S., Bartley, K. et al. Lower 24-h urinary sodium excretion is associated with hypertension control: the 2010 Heart Follow-Up Study. J Hum Hypertens (2019) doi:10.1038/s41371-019-0285-9

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