Dose–response association of 24-hour urine sodium and sodium to potassium ratio with nighttime blood pressure at older ages

Abstract

Aims

We investigated the dose–response association of 24-hour urine sodium and potassium with 24-hour ambulatory blood pressure.

Design

Cross-sectional community-based study.

Methods

Among the 1128 participants in the community-based cross-sectional survey, 740 participants (aged 20–70 years) with complete 24-hour urine collection and valid 24-hour ambulatory blood pressure monitoring were included in the study. Participants were grouped into younger (<55 years, n = 523) and older (≥55 years, n = 217).

Results

In the older population, nighttime blood pressure linearly increased with 24-hour urine sodium and the sodium to potassium ratio. For 24-hour urine sodium, adjusted β was 0.171 (95% confidence interval (CI) 0.036–0.305) for nighttime systolic blood pressure and 0.144 (95% CI 0.012–0.276) for nighttime diastolic blood pressure. For the 24-hour urine sodium to potassium ratio, adjusted β was 0.142 (95% CI 0.013–0.270) for nighttime systolic blood pressure and 0.144 (95% CI 0.018–0.270) for nighttime diastolic blood pressure. The 24-hour blood pressure linearly increased with the 24-hour urine sodium to potassium ratio and adjusted β was 0.133 (95% CI 0.003–0.262) for 24-hour systolic blood pressure and 0.123 (95% CI 0.003–0.244) for 24-hour diastolic blood pressure. Daytime blood pressure and 24-hour systolic blood pressure showed a significant but non-linear association with 24-hour urine sodium among the older population. In the younger population, 24-hour urine sodium, potassium and the sodium to potassium ratio were not associated with ambulatory blood pressure.

Conclusion

In the older population, 24-hour urine sodium and the sodium to potassium ratio showed a linear and positive association with nighttime blood pressure, and 24-hour urine sodium was associated with 24-hour systolic blood pressure and daytime blood pressure in a non-linear fashion.

Keywords

Sodium intake ratio of sodium to potassium intake nocturnal blood pressure older

Get full access to this article

View all access options for this article.

References

MacGregor

. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009; 23: 363–384.

Adrogue

Madias

. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007; 356: 1966–1978.

Aburto

Hanson

Gutierrez

et al.

Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013; 346: f1378–f1378.

Cook

Obarzanek

Cutler

et al.

Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med 2009; 169: 32–40.

Macgregor

. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ 2013; 346: f1325–f1325.

Binia

Jaeger

et al.

Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2015; 33: 1509–1520.

Yoshita

Miura

Okayama

et al.

A validation study on food composition tables for the international cooperative INTERMAP study in Japan. Environ Health Prev Med 2005; 10: 150–156.

Mente

O’Donnell

Rangarajan

et al.

Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 2014; 371: 601–611.

Geleijnse

Witteman

Hofman

et al.

Electrolytes are associated with blood pressure at old age: the Rotterdam Study. J Hum Hypertens 1997; 11: 421–423.

10.

Jackson

Cogswell

Zhao

et al.

Association between urinary sodium and potassium excretion and blood pressure among adults in the United States: National Health and Nutrition Examination Survey, 2014. Circulation 2018; 137: 237–246.

11.

Elliott

Stamler

Nichols

et al.

Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group. BMJ 1996; 312: 1249–1253.

12.

Investigators

ABC-H

Roush

Fagard

et al.

Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension. J Hypertens 2014; 32: 2332–2340.

13.

Rhee

Shin

Park

et al.

Sodium intake of a city population in Korea estimated by 24-h urine collection method. Eur J Clin Nutr 2013; 67: 875–880.

14.

O’Brien

Asmar

Beilin

et al.

European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821–848.

15.

Desquilbet

Mariotti

. Dose–response analyses using restricted cubic spline functions in public health research. Stat Med 2010; 29: 1037–1057.

16.

van der Stouwe

Carmeli

Aeschbacher

et al.

Association of 24-hour blood pressure with urinary sodium excretion in healthy adults. Am J Hypertens 2018; 31: 784–791.

17.

McLean

. Measuring population sodium intake: a review of methods. Nutrients 2014; 6: 4651–4662.

18.

Rhee

Kim

Shin

et al.

Estimating 24-hour urine sodium from multiple spot urine samples. J Clin Hypertens (Greenwich) 2017; 19: 431–438.

19.

Brown

Tzoulaki

Candeias

et al.

Salt intakes around the world: implications for public health. Int J Epidemiol 2009; 38: 791–813.

20.

Centonza

Castoldi

Chianca

et al.

Short-term analysis of the relationship between blood pressure and urinary sodium excretion in normotensive subjects. Clin Sci (Lond) 2000; 98: 495–500.

21.

Staessen

Birkenhager

Bulpitt

et al.

The relationship between blood pressure and sodium and potassium excretion during the day and at night. J Hypertens 1993; 11: 443–447.

22.

Weinberger

. Salt sensitivity of blood pressure in humans. Hypertension 1996; 27: 481–490.

23.

Uzu

Kazembe

Ishikawa

et al.

High sodium sensitivity implicates nocturnal hypertension in essential hypertension. Hypertension 1996; 28: 139–142.

24.

Uzu

Kimura

Yamauchi

et al.

Enhanced sodium sensitivity and disturbed circadian rhythm of blood pressure in essential hypertension. J Hypertens 2006; 24: 1627–1632.

25.

Simonetti

Farese

Aregger

et al.

Nocturnal dipping behaviour in normotensive white children and young adults in response to changes in salt intake. J Hypertens 2010; 28: 1027–1033.

26.

Williams

Poulter

Brown

et al.

Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004; 18: 139–185.

27.

Brown

Cruickshank

Dominiczak

et al.

Better blood pressure control: how to combine drugs. J Hum Hypertens 2003; 17: 81–86.

28.

Overlack

Ruppert

Kolloch

et al.

Divergent hemodynamic and hormonal responses to varying salt intake in normotensive subjects. Hypertension 1993; 22: 331–338.

29.

Burt

Whelton

Roccella

et al.

Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313.

30.

Rodrigues

Baldo

Machado

et al.

High potassium intake blunts the effect of elevated sodium intake on blood pressure levels. J Am Soc Hypertens 2014; 8: 232–238.

31.

Luft

Fineberg

Sloan

. Estimating dietary sodium intake in individuals receiving a randomly fluctuating intake. Hypertension 1982; 4: 805–808.

32.

Keren

Leibowitz

Grossman

et al.

Limited reproducibility of 24-h ambulatory blood pressure monitoring. Clin Exp Hypertens 2015; 37: 599–603.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.27 MB