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

ABSTRACT: 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.

SUBMITTER: Elfassy T

PROVIDER: S-EPMC7211546 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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

Elfassy Tali T Chamany Shadi S Bartley Katherine K Yi Stella S SS Angell Sonia Y SY

Journal of human hypertension 20191111 9

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 ...[more]

PMID: 31712712

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Project description:BackgroundThe relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method.MethodsWe included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis.ResultsAmong 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94).ConclusionsHigher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose-response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels. (Funded by the American Heart Association and the National Institutes of Health.).

Project description:ImportanceIn 2010, the Institute of Medicine (now the National Academy of Medicine) recommended collecting 24-hour urine to estimate US sodium intake because previous studies indicated 90% of sodium consumed was excreted in urine.ObjectiveTo estimate mean population sodium intake and describe urinary potassium excretion among US adults.Design, setting, and participantsIn a nationally representative cross-sectional survey of the US noninstitutionalized population, 827 of 1103 (75%) randomly selected, nonpregnant participants aged 20 to 69 years in the examination component of the National Health and Nutrition Examination Survey (NHANES) collected at least one 24-hour urine specimen in 2014. The overall survey response rate for the 24-hour urine collection was approximately 50% (75% [24-hour urine component response rate] × 66% [examination component response rate]).Exposures24-hour collection of urine.Main outcomes and measuresMean 24-hour urinary sodium and potassium excretion. Weighted national estimates of demographic and health characteristics and mean electrolyte excretion accounting for the complex survey design, selection probabilities, and nonresponse.ResultsThe study sample (n = 827) represented a population of whom 48.8% were men; 63.7% were non-Hispanic white, 15.8% Hispanic, 11.9% non-Hispanic black, and 5.6% non-Hispanic Asian; 43.5% had hypertension (according to 2017 hypertension guidelines); and 10.0% reported a diagnosis of diabetes. Overall mean 24-hour urinary sodium excretion was 3608 mg (95% CI, 3414-3803). The overall median was 3320 mg (interquartile range, 2308-4524). In secondary analyses by sex, mean sodium excretion was 4205 mg (95% CI, 3959-4452) in men (n = 421) and 3039 mg (95% CI, 2844-3234) in women (n = 406). By age group, mean sodium excretion was 3699 mg (95% CI, 3449-3949) in adults aged 20 to 44 years (n = 432) and 3507 mg (95% CI, 3266-3748) in adults aged 45 to 69 years (n = 395). Overall mean 24-hour urinary potassium excretion was 2155 mg (95% CI, 2030-2280); by sex, 2399 mg (95% CI, 2253-2545) in men and 1922 mg (95% CI, 1757-2086) in women; and by age, 1986 mg (95% CI, 1878-2094) in adults aged 20 to 44 years and 2343 mg (95% CI, 2151-2534) in adults aged 45 to 69 years.Conclusions and relevanceIn cross-sectional data from a 2014 sample of US adults, estimated mean sodium intake was 3608 mg per day. The findings provide a benchmark for future studies.

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

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

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