Effect of reduced dietary sodium on blood pressure - A meta-analysis of randomized controlled trials

Objective.-To ascertain whether restriction of dietary sodium lowers blood pressure in hypertensive and normotensive individuals. Data Sources.-An English-language computerized literature search, restricted to human studies with Medical Subject Heading terms, ''hypertension,'' ''blood pressure,'' ''vascular resistance,'' ''sodium and dietary,'' ''diet and sodium restricted, ''sodium chloride,'' ''clinical trial,'' ''randomized controlled trial,'' and ''prospective studies,'' was conducted. Bibliographies of review articles and personal files were also searched. Trial Selection.-Trials that had randomized allocation to control and dietary sodium intervention groups, monitored by timed sodium excretion, with outcome measures of both systolic and diastolic blood pressure were selected by blinded review of the methods section. Data Extraction.-Two observers extracted data independently, using purpose-designed forms, and discrepancies were resolved by discussion. Data Synthesis.-The 56 trials that met our inclusion criteria showed significant heterogeneity. Publication bias was also evident. The mean reduction (95% confidence interval) in daily urinary sodium excretion, a proxy measure of dietary sodium intake, was 95 mmol/d (71-119 mmol/d) in 28 trials with 1131 hypertensive subjects and 125 mmol/d (95-156 mmol/d) in 28 trials with 2374 normotensive subjects. After adjustment for measurement error of urinary sodium excretion, the decrease in blood pressure for a 100-mmol/d reduction in daily sodium excretion was 3.7 mm Hg (2.35-5.05 mm Hg) for systolic (P<.001) and 0.9 mm Hg (-0.13 to 1.85 mm Hg) for diastolic (P=.09) in the hypertensive trials, and 1.0 mm Hg (0.51-1.56 mm Hg) for systolic (P<.001) and 0.1 mm Hg (-0.32 to 0.51 mm Hg) for diastolic (P=.64) in the normotensive trials. Decreases in blood pressure were larger in trials of older hypertensive individuals and small and nonsignificant in trials of normotensive individuals whose meals were prepared and who lived outside the institution setting. Conclusion.-Dietary sodium restriction for older hypertensive individuals might be considered, but the evidence in the normotensive population does not support current recommendations for universal dietary sodium restriction.