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Blood Pressure-Lowering Medications, Sodium Reduction, and Blood Pressure
Jing Song1, Liangkai Chen2,3, Hui Xiong4
1Centre for Public Health and Policy, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., S.P.-R., G.A.M., F.J.H.).
Insights
Reducing sodium intake significantly lowers blood pressure in treated hypertensive patients. The effectiveness of sodium reduction varies depending on the class of blood pressure-lowering medications used.
Area of Science:
- Cardiovascular Medicine
- Clinical Pharmacology
- Nutritional Science
Background:
- Hypertension management involves both medication and lifestyle changes like sodium reduction.
- The differential impact of sodium reduction across various antihypertensive drug classes remains incompletely understood.
Purpose of the Study:
- To investigate the dose-response relationship between sodium intake reduction and blood pressure control in individuals with hypertension receiving medication.
- To assess how different classes of blood pressure-lowering drugs influence the blood pressure response to sodium reduction.
Main Methods:
- A systematic literature search was conducted up to July 9, 2024, identifying randomized controlled trials.
- Meta-analyses using instrumental variable and random-effects models evaluated the dose-response effect of sodium reduction (measured by 24-hour urinary sodium excretion) on blood pressure.
- Subgroup analyses explored variations based on antihypertensive drug class, age, baseline sodium/blood pressure, and study duration.
Main Results:
- Thirty-five studies with 2885 participants were included, with a median study duration of 28 days.
- A 100 mmol reduction in 24-hour urinary sodium excretion correlated with significant decreases in systolic blood pressure (6.81 mm Hg), diastolic blood pressure (3.85 mm Hg), and mean arterial pressure (4.83 mm Hg).
- The blood pressure-lowering effect of sodium reduction was more pronounced with beta-blockers, renin-angiotensin-aldosterone system inhibitors, and dual therapy, but not significantly different across other subgroups.
Conclusions:
- A clear dose-response association exists between reduced sodium intake and lower blood pressure in treated hypertensive individuals.
- The magnitude of blood pressure reduction from sodium restriction is modulated by the specific class of antihypertensive medication being used.
Background:
Both blood pressure-lowering medication and sodium reduction are effective in hypertension control, but whether the effect of sodium reduction differ across blood pressure-lowering medications is unclear. This study aims to evaluate the dose-response effect of sodium intake reduction on blood pressure in treated hypertensive individuals and the impact of different classes of blood pressure-lowering drugs.
Methods:
We searched multiple databases and reference lists up to July 9, 2024. Randomized controlled trials with a duration of ≥2 weeks comparing the effect of different levels of sodium intake (measured by 24-hour urinary sodium excretion) on blood pressure in hypertensive individuals treated with constant blood pressure-lowering medications were included. Instrumental variable meta-analyses based on random-effects models were conducted to evaluate the dose effect of sodium reduction on blood pressure. Subgroup analyses were performed based on the class of blood pressure-lowering drugs, age, baseline sodium and blood pressure levels, and study duration.
Results:
We included 35 studies (median duration of 28 days) with a total of 2885 participants. For every 100 mmol reduction in 24-hour urinary sodium excretion, systolic blood pressure decreased by 6.81 mm Hg (95% CI, 4.96-8.66), diastolic blood pressure decreased by 3.85 mm Hg (95% CI, 2.26-5.43), and mean arterial pressure decreased by 4.83 mm Hg (95% CI, 3.22-6.44). The dose-response effects varied across classes of blood pressure-lowering medications, with greater effects observed in the β-blockers, renin-angiotensin-aldosterone system inhibitors, and dual therapy groups. No significant subgroup differences were observed across subgroups defined by age, baseline 24-hour urinary sodium excretion, blood pressure levels, or study duration.
Conclusions:
Pooled evidence suggests a dose-response relationship between sodium reduction and blood pressure in treated individuals with hypertension, influenced by the class of blood pressure-lowering medications.
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