Recommending Salt Intake Reduction to the Hypertensive Patient
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REVIEW ARTICLE
Adis ª 2012 Springer International Publishing AG. All rights reserved.
Recommending Salt Intake Reduction to the Hypertensive Patient More Than Just Lip Service Pasquale Strazzullo,1 Lanfranco D’Elia,1 Giulia Cairella,2 Luca Scalfi3 and Michele Schiano di Cola1 1 Department of Clinical and Experimental Medicine, ESH Excellence Centre of Hypertension, ‘‘Federico II’’ University of Naples, Naples, Italy 2 Department of Prevention, Rome B Health Service Unit, Rome, Italy 3 Department of Food Science, ‘‘Federico II’’ University of Naples, Naples, Italy
Contents Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 2. Why and How Should Salt Intake be Reduced? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 3. Are There People Who Can Expect Particularly Favourable Results from Reducing Salt Intake? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4. What Elements are to be Considered When Prescribing Salt Intake Reduction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5. Monitoring of Salt Intake Reduction in Hypertensive Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Abstract
The average individual dietary salt intake largely exceeds the physiological needs almost worldwide. A direct causal association between salt intake and blood pressure levels has been clearly established. Furthermore, there is increasing evidence for additional blood pressure-independent pathways linking excess salt intake to the process of atherosclerosis. Recent meta-analyses of randomized controlled trials showed that moderate reduction of salt intake is associated with reduction of blood pressure and, in perspective, with reduction of cardiovascular and cerebrovascular events in hypertensive individuals. According to the European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension, instructions to reduce dietary salt intake to the level of 5 g/day based on the WHO recommendation should be provided to all patients, regardless of their requirement for drug treatment. Unfortunately, the patients’ response to this measure is heterogeneous, mainly due to variable compliance with the doctor’s prescription and to a lesser extent
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