# Is there any proof that salt is related to hypertension? **URL:** \ **Category:** Factual Questions\ **Created:** [October 24, 2010, 3:34pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190 "2010-10-24T15:34:58Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [July 12, 2011, 9:18pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/21 "2011-07-12T21:18:46Z")
> [@Surreal](#): > > You might be interested in the latest Cochrane Review, which completely debunks the studies you listed above. > > [http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD009217/frame.html](http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD009217/frame.html) “Completely debunks”? Hardly. Let’s see: with their analysis confined to **seven** studies involving fewer than 7,000 subjects (in contrast, for example, to the 2009 meta-analysis above involving 177,000 subjects), the authors concluded, “There was not enough information to understand the effect of these changes in salt intake on deaths or cardiovascular disease. Further research (is) needed . . .”. To say that such a modest and essentially neutral conclusion “debunks” decades of research involving hundreds of thousands of subjects is just a tad of an overstatement. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [July 12, 2011, 9:46pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/22 "2011-07-12T21:46:06Z")
By the way, today’s issue of Archives of Internal Medicine contains the [results](http://archinte.ama-assn.org/cgi/content/abstract/171/13/1183) of a study looking at the dietary salt (sodium) intake of more than 12,000 people followed for over 15 years. And, what were the conclusions of this study?: “. . . higher sodium intake is associated with increased total mortality in the general US population”. Did the results appear to apply in general, or just to specific groups (such as those with high blood pressure, etc.)?: “(the) findings did not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity.” Hey, I’m not saying this one, non-randomized trial “completely debunks” anything or proves very much. Rather, it’s just the latest one of the many, many pieces of research which all point to the same conclusion: that high salt (sodium) intake is associated with bad outcomes. ---
**Author:** ![barbitu8](https://avatars.discourse-cdn.com/v4/letter/b/839c29/32.png) [@barbitu8](https://boards.straightdope.com/u/barbitu8)\ **Post date:** [July 14, 2011, 8:03pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/23 "2011-07-14T20:03:12Z")
> **[Sodium and Potassium Together Determine Risk for Heart Disease Death](https://www.scientificamerican.com/podcast/episode/sodium-and-potassium-together-deter-11-07-12/)** > > A new study says high sodium and low potassium intake are the twin culprits in many cardiovascular syndromes. Katherine Harmon reports This indicates that it is the combo of high salt and low potassium intakes that leads to problems. ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [July 14, 2011, 8:08pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/24 "2011-07-14T20:08:57Z")
> [@Shmendrik](#): > > IIRC, sweat is hypotonic, so if anything sweating would somewhat increase sodium concentration. But not if you replenish the water you lost it with a liquid containing less sodium than the sweat, such as straight water or many drinks. ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [November 18, 2011, 7:05pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/25 "2011-11-18T19:05:55Z")
Not that this will change the minds of the zealots who think that everyone needs to eliminate sodium from their diet, but here’s the latest from the prestigious Cochrane Collaboration: [http://www.washingtonpost.com/blogs/the-checkup/post/salt-intake-reduction-may-not-reduce-disease-analysis-concludes/2011/11/07/gIQACJYW1M\_blog.html](http://www.washingtonpost.com/blogs/the-checkup/post/salt-intake-reduction-may-not-reduce-disease-analysis-concludes/2011/11/07/gIQACJYW1M_blog.html) > [@](#): > > The new analysis was conducted by Niels Graudal of Copenhagen University Hospital in Denmark for the Cochrane Collaboration, a highly respected international group that assesses scientific evidence for health issues. Graudal and his colleagues analyzed **167 studies conducted between 1950 and 2011** that compared people who consumed low-sodium versus high-sodium diets. > **Low-sodium diets did cut blood pressure levels in people with high and normal blood pressure, the researchers found. But it also significantly increased other risk factors for heart disease, such as cholesterol levels, triglycerides, adrenaline and renin, the researchers reported in the American Journal of Hypertension.** The reduction in blood pressure in normotensives was only around 1%, but triglycerides increased by 7%. ---
**Author:** ![OpalCat](https://avatars.discourse-cdn.com/v4/letter/o/8edcca/32.png) [@OpalCat](https://boards.straightdope.com/u/OpalCat)\ **Post date:** [November 18, 2011, 8:26pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/26 "2011-11-18T20:26:04Z")
> [@Nava](#): > > **Portwest** , got anything about salt on hypotensive subjects? I’ve had to calm down both medical personnel and pharmacy techs when they saw my BP and claimed there was no way I could be upright with those numbers; the “quick and dirty” solution for when I’m feeling dizzy, as ordered by several doctors throughout the years is a handful of salty peanuts (if that doesn’t work, there are stronger measures, but that often makes the dizzy go away). I have low blood pressure as well, though as I’ve gotten older it’s gone up a bit and is approaching normal now. I was told from a very early age by my doctor that I should eat salty foods and put salt on foods to keep myself from having dizzy/fainting spells. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [November 18, 2011, 8:53pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/27 "2011-11-18T20:53:32Z")
> [@](#): > > Not that this will change the minds of the zealots who think that everyone needs to eliminate sodium from their diet, Who, exactly, are those folks? Everyone agrees that we need some salt; the dispute is just over how much. ---
**Author:** ![srzss05](https://avatars.discourse-cdn.com/v4/letter/s/898d66/32.png) [@srzss05](https://boards.straightdope.com/u/srzss05)\ **Post date:** [November 18, 2011, 9:03pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/28 "2011-11-18T21:03:27Z")
> [@Chronos](#): > > Who, exactly, are those folks? Everyone agrees that we need some salt; the dispute is just over how much. I was kind of curious as to why he feels this has to be brought up every few months if he thinks it won’t convince “them”. ---
**Author:** ![heavyarms553](https://avatars.discourse-cdn.com/v4/letter/h/779978/32.png) [@heavyarms553](https://boards.straightdope.com/u/heavyarms553)\ **Post date:** [November 18, 2011, 9:40pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/29 "2011-11-18T21:40:57Z")
Yeah, I’ve seen CHFers decompensate by binging on salty food. Its bad, mmk? ---
**Author:** ![abderian](https://avatars.discourse-cdn.com/v4/letter/a/9de0a6/32.png) [@abderian](https://boards.straightdope.com/u/abderian)\ **Post date:** [November 18, 2011, 10:23pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/30 "2011-11-18T22:23:08Z")
> [@OpalCat](#): > > I have low blood pressure as well, though as I’ve gotten older it’s gone up a bit and is approaching normal now. I was told from a very early age by my doctor that I should eat salty foods and put salt on foods to keep myself from having dizzy/fainting spells. I had the same issue and was told the same thing, Opal. But then I got old and fat and, well, here I am with regular old hypertension. It gets worse if I consume too much sodium. ---
**Author:** ![thelabdude](https://avatars.discourse-cdn.com/v4/letter/t/dc4da7/32.png) [@thelabdude](https://boards.straightdope.com/u/thelabdude)\ **Post date:** [November 18, 2011, 11:53pm UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/31 "2011-11-18T23:53:00Z")
My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [November 19, 2011, 1:03am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/32 "2011-11-19T01:03:27Z")
> [@thelabdude](#): > > My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt. We can’t win. If docs advocate the low salt approach, we’re lambasted by the likes of **surreal**. OTOH, if we prescribe meds for high blood pressure, you proceed to traduce us. Well, if I’m going to get dissed either way, I might as well get paid for it. So, you can please point me in the direction of those “kick backs” I can be getting. How do I sign up? (note - I’m really depending on you for directions, because in thirty years I’ve never even been offered a kick back, let alone got one. Please don’t let me down, okay?) ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 19, 2011, 1:23am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/33 "2011-11-19T01:23:06Z")
> [@KarlGauss](#): > > Well, if I’m going to get dissed either way, I might as well get paid for it. So, you can please point me in the direction of those “kick backs” I can be getting. How do I sign up? (note - I’m really depending on you for directions, because in thirty years I’ve never even been offered a kick back, let alone got one. Please don’t let me down, okay?) Me too. Though I got some free pens a few times. Cheap ones, but free. Also a viagra-shaped stress ball. :dubious: ---
**Author:** ![VOW](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/vow/32/3043_2.png) [@VOW](https://boards.straightdope.com/u/VOW)\ **Post date:** [November 19, 2011, 1:29am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/34 "2011-11-19T01:29:05Z")
To thelabdude: I think your impression is due to the fact that many (if not most) people do not take high blood pressure seriously. Until the complications set in, there are essentially no symptoms. A patient who is told, “You are borderline hypertensive. Cut back on the salt, lose ten pounds, and come back to see me. We need to monitor your blood pressure.” If the patient returns in six months, chances are excellent he or she will have gained an additional ten pounds, and probably keeps eating the same amount of sodium. A BP check will show graduation into actual hypertension. The first line of treatment will be a water pill. The patient will receive a prescription and told the same instructions: “Cut back on your salt, lose at least ten pounds, and get 30 minutes of exercise every day.” Wanna guess what happens at the next doctor appointment? ~VOW ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [November 19, 2011, 1:55am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/35 "2011-11-19T01:55:05Z")
I _had_, in the past, been offered nice dinners to come and listen to sales pitches … always threw away the invite sayin’ “everyone has their price but they aint hit mine yet.” Then some salesperson left me a bouncy ball that lit up when you bounced it … _now_ you’re talking my price! To our Adult MDs - Should the general population (normotensive) be on a lower salt diet than we currently are on? If so, how low? Just “no added salt” (NAS) or lower? How much sodium does someone on a NAS diet ingest typically? What percent of those with hypertension will respond to a low salt diet? And how low do they need to go? ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [November 19, 2011, 2:13am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/36 "2011-11-19T02:13:11Z")
> [@DSeid](#): > > Should the general population (normotensive) be on a lower salt diet than we currently are on? If so, how low? Just “no added salt” (NAS) or lower? How much sodium does someone on a NAS diet ingest typically? I can’t do better than quoting the introductory paragraph from the NEJM link above: > [@NEJM](#): > > The U.S. diet is high in salt. The Departments of Agriculture and Health and Human Services recommend daily intake of less than 5.8 g of salt (2300 mg of sodium), with a lower target of 3.7 g of salt per day for most adults (persons over 40 years of age, blacks, and persons with hypertension). Despite these guidelines, during the period from 2005 through 2006, the average man in the United States is estimated to have consumed 10.4 g of salt per day and the average woman 7.3 g per day — amounts that exceed those in preceding years > [@DSeid](#): > > What percent of those with hypertension will respond to a low salt diet? And how low do they need to go? [Here is a detailed review](http://hyper.ahajournals.org/content/27/3/481.long). It’s old but answers your questions. Basically, about half of hypertensives will respond to dietary salt restriction and even a quarter or so of normotensive people will do likewise (i.e. BP up with salt, and BP down when it’s restricted). How low? For most people, less than 4 grams may be ideal (again, see [the NEJM paper, above](http://www.nejm.org/doi/full/10.1056/NEJMoa0907355#t=article)). ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [November 19, 2011, 2:17am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/37 "2011-11-19T02:17:35Z")
> [@thelabdude](#): > > My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt. My husband’s hypertension drug costs him $10/month. Cost without insurance might be $20. There are plenty of cheap anti-hypertension drugs. (And speaking as someone who works in a doctor’s office (ophthalmology), we don’t even get free samples any longer, unless they’re vitamins or OTC drops for dry eye. I got a couple pens, though.) Side note: When should you worry about low blood pressure? I read at 90/60 at my most recent checkup, 95/78 before that. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [November 19, 2011, 2:34am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/38 "2011-11-19T02:34:12Z")
> [@Ferret\_Herder](#): > > My husband’s hypertension drug costs him $10/month. Cost without insurance might be $20. There are plenty of cheap anti-hypertension drugs. Great point. And [they are as good, if not better, than anything else](http://jama.ama-assn.org/content/283/15/1967.long). > [@](#): > > When should you worry about low blood pressure? I’d say only if the person is symptomatic - i.e. if they’re getting light-headed. This underscores the point that many, young healthy women (in particular) have BPs in the 90’s or even 80’s. That is normal (unless, as stated, they’re getting dizzy). The reason that isn’t more appreciated is that docs (and BP research) focus on one end of the BP spectrum which tends to make us overlook the other, normal, end. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [November 19, 2011, 2:47am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/39 "2011-11-19T02:47:46Z")
> [@KarlGauss](#): > > I can’t do better than … Thank you. Yes those do suffice. If I understand then, a NAS diet (with special emphasis on limiting intake of processed foods, which tend to be high in sodium) should be enough to get under the 4g mark. ---
**Author:** ![Hirka\_T\_Bawa](https://avatars.discourse-cdn.com/v4/letter/h/db5fbb/32.png) [@Hirka\_T\_Bawa](https://boards.straightdope.com/u/Hirka_T_Bawa)\ **Post date:** [November 19, 2011, 3:38am UTC](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190/40 "2011-11-19T03:38:33Z")
> [@Ferret\_Herder](#): > > Side note: When should you worry about low blood pressure? I read at 90/60 at my most recent checkup, 95/78 before that. > [@KarlGauss](#): > > I’d say only if the person is symptomatic - i.e. if they’re getting light-headed. This underscores the point that many, young healthy women (in particular) have BPs in the 90’s or even 80’s. That is normal (unless, as stated, they’re getting dizzy). The reason that isn’t more appreciated is that docs (and BP research) focus on one end of the BP spectrum which tends to make us overlook the other, normal, end. What I’ve always learned, was that what matters in low BP is the [Mean Arterial Pressure](http://en.wikipedia.org/wiki/Mean_arterial_pressure) (MAP). This measures the average BP, and when it is too low there is risk that the organs at the end of the line aren’t getting enough blood and will become ischemic (not get enough oxygen). MAP has a fancy calculation, to estimate, but the simplified version is the average of your systolic and diastolic BP’s, so someone with a BP of 120/80, would have an estimated MAP of 100 (if you actually perform the equations, it comes out to approx 93, so in most cases the average is good enough, and WAY easier to remember). A MAP of 60mmHg is normally considered good enough to avoid problems with a low BP. **KarlGauss** , is that basically correct? I learned that during my Internal Med rotation, and it was the rule the MD’s there used. Though, that was with really sick patients, so the “if symptomatic” approach wouldn’t work. Hirka T’Bawa, PharmD. I’ve always wanted to sign a post that way, and think this is the first medical related post I’ve made since I graduated! [Previous page](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190.md?page=1) [Next page](https://boards.straightdope.com/t/is-there-any-proof-that-salt-is-related-to-hypertension/558190.md?page=3)