Discussion
In the current study, using data from the DASH–Sodium trial, during screening when participants are consuming their normal dietary intake, we report a slope increment of an elevation in SBP of approximately 3 mmHg across the urinary Na + excretion range of 2–5 g/day in SS, but not SR participants. However, when assessed across the full range of observed urinary Na + excretion values we did not observe a positive correlation between SBP and urinary Na + excretion in either SS or SR participants. Significantly, despite urinary K + excretion of <1 g K + /day associating with higher SBP in SS and SR participants further increments in urinary K + excretion did not correlate with a reduction in SBP in either participant group. Furthermore, at baseline screening we did not observe a correlation between the urinary Na + :K + excretion ratio irrespective of the salt sensitivity of blood pressure. As such our data, from the DASH–Sodium Trial, in US participants at both baseline screening and following a highly controlled dietary intervention does not support the hypothesis that a reduced urinary Na + :K + ratio will be beneficial in population level blood pressure reduction or support the proposal for a urinary Na + :K + molar ratio of <1 to lower blood pressure.
Following the Dashboard slimming down input i seen no relationship ranging from a good urinary Na + :K + ratio and SBP in either SS otherwise SR participants
Compared with the Natural , INTERSALT , and you may INTERMAP studies, one to situated a society height self-confident association anywhere between urinary Na + removal and you may blood circulation pressure, this new Dash–Sodium Trial enables the new place of the sodium awareness of bloodstream pressure inside the demo participants. Having said that, in SS players we noticed a slope increment away from a rise in the SBP of 1.step 3 mmHg for every single step 1 g rise in urinary Na + excretion along the excretion directory of step three–5 g Na + /date which is within normal mediocre selection of every day Na + intake in the us . Having said that, whenever assessed along the whole variety of seen urinary Na + removal, we noticed no association ranging from urinary Na + excretion and you may SBP either in SS otherwise SR members. I speculate it difference ranging from an optimistic dating between SBP and you may urinary Na + removal during the expected variety of losing weight Na + excretion out of 3–5 grams/big date without connection along side over set of values reflects the newest feeling away from numerous members from the Dash–Salt studies showing large quantities of urinary Na + removal, greater than 5 g/big date, and comparatively lowest blood pressure. Notably, the benefits obtained inside study to have an increase in SBP inside step 3–5 grams/date Na + excretion resembles one to gotten throughout the Natural studies hence claimed a positive slope increment off a-1.7 mmHg upsurge in SBP for every single step one grams upsurge in urinary Na + removal along side exact same listing of Na + removal values . The difference between the latest seen escalation in SBP in response so you’re able to elevated urinary Na + excretion anywhere between Dashboard-Salt and you will Sheer ple size and you may racial backgrounds of one’s professionals and (2) the which is better eHarmony vs Match potential differences in ways to assess urine articles off twenty-four-h pee range compared to the an estimate from day place pee decide to try from the Dashboard-Sodium rather than Natural Analysis respectively. Our analysis assistance advice to help you limitation dietary Na + intake [5, 24] and you may recommend that reduced dietary sodium intake might only lower SBP for the SS patients.
The influence of K + intake on blood pressure remains controversial, with conflicting data emerging from multiple clinical studies . In a randomized controlled trial conducted in free living non-dietary regulated participants with a mean SBP of 132 mmHg and not taking blood pressure lowering medication, K + intake was increased by dietary intake (via fruit and vegetable intake) or direct K + supplements. In this study increased K + intake up to 40 mmol/day had no impact on blood pressure [22, 26]. A separate randomized placebo-controlled crossover trial was conducted in participants who have never received antihypertensive medication with mildly elevated blood pressure . Participants were maintained on their normal diet and received K + at 64 mmol/day for a 4-week period as either potassium chloride or bicarbonate-in this study there was no effect of K + supplementation on office blood pressure . In contrast in a randomized placebo-controlled, crossover study, in which untreated patients with a mean SBP of 145 mmHg blood pressure received 4 weeks of supplemental K + at 3 g/day and a diet relatively low in Na + reported a reduction in SBP of 3.9 mmHg. Beyond the highly controlled trials discussed above the PURE study reports that for each increment of 1 g/day of urinary K + excretion there is a reduction of 0.75 mmHg in SBP across the excretion range of <1.25 to 3 g K + /day . In the DASH–Sodium data, we observed an elevation in SBP in both SS and SR participants when urinary K + excretion was below 1 g/day. However, we did not observe any correlation between urinary K + excretion and SBP or an impact of urinary K + excretion on SBP over the range of <1 to >3 g K + excretion per day. We speculate that discrepancy between the PURE study data and our own analysis of the DASH-Sodium data may reflect the difference in SBP response to urinary K + excretion reported in PURE between Chinese and non-Chinese participants. Chinese participants exhibited a large reduction in SBP with increased urinary K + excretion versus a smaller SBP effect in participants from the rest of the world. As the DASH-Sodium trial did not contain Chinese participants this may have influenced the outcome.