Are the conclusions of INTERSALT applicable to the German population?

We distinguish determinants of individual blood pressure elevations and those which influence shape and location of entire population distributions, i.e. epidemiological determinants. Individual and epidemiological determinants are not necessarily the same. Identification of the latter may be used to develop population wide prevention strategies that carry a great potential of reducing the public burden of cardiovascular morbidity and mortality. Salt has long but controversially been suspected as a major etiologic agent in hypertensive populations. For the first time the INTERSALT study tried in a systematic and standardized way to assess the salt-BP association in individuals and across 52 populations in 32 countries. The observed within center relations to systolic and more so to diastolic BP were largely inconsistent in direction and magnitude indicating probable non-uniformity of the salt effect. In this case, statistical pooling of single effect estimates may have lead to invalid conclusions. Across center analyses found no relevant relation of median sodium excretion to median BP values or hypertension prevalence and hence no evidence for salt as an epidemiologic BP determinant. It is concluded that the INTERSALT evidence is not sufficient to warrant salt restriction in the general population. This contrasts with consistent and quantitatively relevant individual and population associations of body mass index with blood pressure in INTERSALT. Considering its potentially multifactorial preventive effects, BMI reduction seems to be a more pragmatic public health measure for the German population.