P1691Impact of dose and duration of dietary salt reduction on blood pressure levels: systematic review and meta-analysis of randomised trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Huang ◽  
K Trieu ◽  
S Yoshimura ◽  
M Woodward ◽  
N Campbell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Sodium Excretion ◽  
Salt Intake ◽  
Meta Analysis ◽  
Dietary Salt ◽  
Baseline Blood Pressure ◽  
Salt Reduction ◽  
The Impact

Abstract Background Authoritative medical and public health agencies in most countries advise to reduce population dietary salt intake to under 5–6 g/day as a strategy for preventing high blood pressure and cardiovascular disease. However, there is still dispute about whether salt reduction should be adopted by all populations. In addition, the effect of duration of dietary salt reduction has not been sufficiently investigated. Purpose To understand the effect of dietary salt reduction on blood pressure and the impact of intervention duration. Methods A systematic review and meta-analysis was conducted. Randomized controlled trials that allocated participants to low and high salt intake, without confounding from unequal concomitant interventions, were included. We excluded studies done in individuals younger than 18 years, pregnant women, individuals with renal disease or heart failure, and studies with sodium excretion estimated from spot urine. Random effect meta-analysis was used to generate pooled estimates of the effect on 24-hour urinary sodium excretion, systolic and diastolic blood pressure. Multivariate meta-regression was used to quantify the dose response effect of dietary salt on blood pressure change and to understand the impact of the intervention duration. Results 125 studies were included with 162 data points extracted. Ninety-nine data points (61%) had interventions under 4 weeks. Overall, 24-hour urinary sodium excretion changed by −141 mmol (95% CI: −156; −126), systolic blood pressure changed by −4.4 mm Hg (95% CI: −5.2; −3.7) and diastolic blood pressure changed by −2.4 mm Hg (95% CI: −2.9; −1.9). Sodium reduction resulted in a significant decrease of systolic blood pressure in all subgroups except in participants with low baseline sodium intake (<109 mmol) (Figure 1). Each 100 mmol reduction of sodium was associated with 2.7 mm Hg (95% CI: 1.0; 4.4; p=0.002) reduction of systolic blood pressure and 1.2 mm Hg (95% CI: 0.0; 2.4; p=0.046) reduction of diastolic blood pressure after adjusting for intervention duration, age, sex, race, baseline blood pressure, baseline sodium intake and interaction between age and baseline blood pressure. For the same amount of salt reduction, a 10 mm Hg higher baseline systolic blood pressure would result in 2.5 mm Hg greater reduction of systolic blood pressure. There is not enough evidence to show the impact of intervention duration. Figure 1 Conclusions Our meta-analysis showed that sodium reduction could reduce blood pressure in all adult populations regardless of age, sex and race. The effect of salt reduction on systolic blood pressure increases with higher baseline blood pressure. Further studies, designed to investigate the impact of intervention duration, are needed to understand the significance of the duration. Acknowledgement/Funding None

scholarly journals The Antihypertensive Effects and Safety of LCZ696 in Patients with Hypertension: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (13) ◽  
pp. 2824
Author(s):  
Su-Kiat Chua ◽  
Wei-Ting Lai ◽  
Lung-Ching Chen ◽  
Huei-Fong Hung
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Meta Analysis ◽  
Systemic Review ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Mean

Background: The management of hypertension remains suboptimal throughout the world. Methods: We performed a random-effects model meta-analysis of randomized controlled trials to determine the effectiveness and safety of sacubitril/valsartan (LCZ696) for the treatment of high arterial pressure. Relevant published articles from PubMed, Cochrane base, and Medline were examined, and the last search date was December 2020. Only published randomized controlled trials and double-blind studies were selected for further analysis. The mean reductions in systolic blood pressure (msSBP) and diastolic blood pressure (msDBP) in the sitting position, as well as the mean reductions in ambulatory systolic blood pressure (maSBP) and ambulatory diastolic blood pressure (maDBP), were assumed as efficacy endpoints. Adverse events (AEs) were considered as safety outcomes. Results: Ten studies with a total of 5931patients were included for analysis. Compared with placebo, LCZ696 had a significant reduction in msSBP (weight mean difference (WMD) = −6.52 mmHg, 95% confidence interval (CI): −8.57 to −4.47; p < 0.001), msDBP (WMD = −3.32 mmHg, 95% CI: −4.57 to −2.07; p < 0.001), maSBP (WMD = −7.08 mmHg, 95% CI: −10.48 to −3.68; p < 0.001), maDBP (WMD = −3.28 mmHg, 95% CI: −4.55 to −2.02, p < 0.001). In subgroup analysis, only 200 mg and 400 mg LCZ696 showed a significant BP reduction. There was no difference in the AE rate between the LCZ696 and placebo groups (WMD = 1.02, 95% CI: 0.83 to 1.27, p = 0.54). Egger’s test revealed a potential publication bias for msSBP (p = 0.025), but no publication bias for other outcomes. Conclusion: LCZ696 may reduce blood pressure more efficaciously than traditional therapy in hypertensive patients without increasing adverse effects.

scholarly journals Assessment of Sodium Knowledge and Urinary Sodium Excretion among Regions of the United Arab Emirates: A Cross-Sectional Study

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2747
Author(s):  
Amjad H. Jarrar ◽  
Lily Stojanovska ◽  
Vasso Apostolopoulos ◽  
Leila Cheikh Ismail ◽  
Jack Feehan ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Sodium Excretion ◽  
Salt Intake ◽  
Urinary Sodium Excretion ◽  
World Health ◽  
High Potassium ◽  
Cross Sectional ◽  
Salt Reduction ◽  
High Salt Intake ◽  
The Impact

Non-communicable diseases (NCDs) such as cardiovascular disease, cancer and diabetes, are increasing worldwide and cause 65% to 78% of deaths in the Gulf Cooperation Council (GCC). A random sample of 477 healthy adults were recruited in the United Arab Emirates (UAE) in the period March–June 2015. Demographic, lifestyle, medical, anthropometric and sodium excretion data were collected. A questionnaire was used to measure knowledge, attitude and practice regarding salt. Mean sodium and potassium excretion were 2713.4 ± 713 mg/day and 1803 ± 618 mg/day, respectively, significantly higher than the World Health Organization (WHO) recommendations for sodium (2300 mg/day) and lower for potassium (3150 mg/day). Two-thirds (67.4%) exceeded sodium guidelines, with males 2.6 times more likely to consume excessively. The majority of the participants add salt during cooking (82.5%) and whilst eating (66%), and 75% identified processed food as high source of salt. Most (69.1%) were aware that excessive salt could cause disease. Most of the UAE population consumes excess sodium and insufficient potassium, likely increasing the risk of NCDs. Despite most participants being aware that high salt intake is associated with adverse health outcomes, this did not translate into salt reduction action. Low-sodium, high-potassium dietary interventions such as the Mediterranean diet are vital in reducing the impact of NCDs in the UAE.

scholarly journals Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Li Ran ◽  
Wenli Zhao ◽  
Xiaodong Tan ◽  
Hongwu Wang ◽  
Kaito Mizuno ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vitamin C ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Meta Analysis ◽  
Serum Vitamin ◽  
Inverse Correlation ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
English Articles

Background. Hypertension is regarded as a major and independent risk factor of cardiovascular diseases, and numerous studies observed an inverse correlation between vitamin C intake and blood pressure. Aim. Our aim is to investigate the relationship between serum vitamin C and blood pressure, including the concentration differences and the correlation strength. Method. Two independent researchers searched and screened articles from the National Library of Medicine, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP databases, and WANFANG databases. A total of 18 eligible studies were analyzed in the Reviewer Manager 5.3 software, including 14 English articles and 4 Chinese articles. Results. In the evaluation of serum vitamin C levels, the concentration in hypertensive subjects is 15.13 μmol/L lower than the normotensive ones (mean difference=−15.13, 95% CI [-24.19, -6.06], and P=0.001). Serum vitamin C has a significant inverse relation with both systolic blood pressure (Fisher’s Z=−0.17, 95% CI [-0.20, -0.15], P<0.00001) and diastolic blood pressure (Fisher’s Z=−0.15, 95% CI [-0.20, -0.10], P<0.00001). Conclusions. People with hypertension have a relatively low serum vitamin C, and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.

scholarly journals A Meta-Analysis on the Effect and Safety of LCZ696 in the Treatment of Hypertension

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Li Zheng ◽  
Binbin Xia ◽  
Xuqian Zhang ◽  
Yan Zhao
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Blood Pressure Level ◽  
Evaluation Standard ◽  
Treatment Of Hypertension ◽  
Patient Will ◽  
Receptor Blockers

Objectives. To systematically evaluate the differences in effect and safety of LCZ696 and angiotensin receptor blockers (ARBs) in the treatment of hypertension. Methods. We searched PubMed, Cochrane, Web of Science, and Ovid, collected randomized controlled trials (RCTs) about the effect and safety of LCZ696 and ARBs in hypertensive patients, extracted relevant data and evaluated the quality of the included literature according to the RCT quality evaluation standard recommended by Cochrane Reviewer’s Handbook, using RevMan 5.3, and performed meta-analysis. Results. Eight RCTs studies were included, with a total of 4313 patients. Compared with ARBs, LCZ696 can better reduce systolic blood pressure (msSBP) (WMD −4.29 mmHg; 95% CI: −5.37 to −3.21; P  < 0.001), diastolic blood pressure (msDBP) (WMD −1.87 mmHg; 95% CI:−2.38 to −1.36; P  < 0.01), ambulatory systolic blood pressure (maSBP) (WMD −3.37 mmHg; 95% CI:−4.26 to −2.47; P  < 0.01), and ambulatory diastolic blood pressure (maDBP) (WMD −1.47 mmHg; 95% CI: −1.97 to −0.97; P  < 0.01). In terms of safety, LCZ696 is basically the same as ARBs, but LCZ696 is more likely to cause cough than ARBs (OR = 2.38; 95% CI: 1.27 to 4.47; P  < 0.01). Conclusion. LCZ696 can significantly reduce the blood pressure level of patients with hypertension, but it is necessary to pay attention to whether the patient will experience coughing after taking the drug.

scholarly journals Barriers of dietary salt reduction among hypertensive patients: a cross sectional study

2020 ◽  
Vol 7 (9) ◽  
pp. 3459
Author(s):  
Mariyam Khwaja
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Lifestyle Modification ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Dietary Salt ◽  
Cross Sectional ◽  
Salt Reduction ◽  
Hypertensive Patients ◽  
Dietary Salt Intake

Background: Healthy dietary practice is an important lifestyle modification and one of the key adjuncts to pharmacotherapy in management of hypertension. A modest reduction in salt intake of 5 gm/day lowered blood pressure by 7/4 mmHg diastolic in hypertensive patients. Despite knowledge about the ill consequences, many people continue to consume high levels of salt in their diet. To motivate people to reduce salt in their diet, a solid understanding of barriers encountered by those under salt reduction recommendation is necessary. Hence, this study was conducted with the aim of identifying the barriers to dietary salt reduction among hypertensive patients.Methods: A community based cross sectional study was conducted on a sample of 356 hypertensive patients in field practice areas (urban and rural) in Department of Community Medicine, JNMC, AMU, Aligarh. A pretested semi-structured questionnaire was used for the study. Compliance to dietary salt intake was assessed by calculating average salt intake per person per day. The tenets of health belief model were used to examine the key determinants of human behavior. Analysis was done by using correlation, proportions, chi-square and multiple linear regression.Results: 31.4% of the participants took salt <5 gm per day. A significant association was noticed with area, religion, social class, family size, perceived benefits and perceived susceptibility. A significant positive correlation was seen with total adherence score and family size.Conclusions: A lot of barriers hinder the compliance to dietary salt reduction. Health Education stressing the role of salt reduction in control of blood pressure is recommended.

scholarly journals The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Patoulias ◽  
A Boulmpou ◽  
C E Papadopoulos ◽  
F Siskos ◽  
K Stavropoulos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Background Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure. Purpose We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs). Methods We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM. Results After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2). Conclusions Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Salt reduction in bread: Is it enough? Preliminary results of a HIA in Portugal

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Santos ◽  
P Braz ◽  
A Costa ◽  
L Costa ◽  
M Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Statistical Difference ◽  
Salt Intake ◽  
Statistical Significance ◽  
Systolic Pressure ◽  
Health Impact ◽  
World Health ◽  
Salt Reduction ◽  
Aggregated Data ◽  
The Impact

Abstract Issue Health Impact Assessment (HIA) is a methodology that aims at assessing the impact of policies in health. A pilot HIA is in progress to kick off the implementation of this methodology in Portugal with the support of the World Health Organization (WHO). In this context, the impact of a nation-wide policy that intends to achieve a maximum of 1 g of salt/100 gr in bread is under assessment. Description of the issue In 2017, Portugal approved a protocol between the industry and other stakeholders to gradually decrease the amount of salt in bread, as this is the main source of salt intake. The purpose of this study was to assess the impact in blood pressure from current (1.4 gr) to 1 g (29% reduction) of salt in bread. Data from two different surveys regarding blood pressure and salt intake was gathered. We estimated the decrease in blood pressure with respect to current average values according to sex, age, education and region. Results It is expected that a reduction of 29% in salt intake through bread contributes to a general decrease in systolic pressure for normotensive people (from 120.4mmHg to 120.0mmHg, p = 0.85) and hypertensive people (from 151.0mmHg to 150.1mmHg, p = 0.68), although not statistically significant. Older hypertensive individuals (65 to 75 years) are the group with the largest benefit (152.8mmHg to 152.0mmHg) but no statistical difference was found. Disaggregation by sex, region and education also didn’t show any statistical difference. Lessons The impact in blood pressure from a 29% reduction in salt intake from bread seems very small. We found no statistical significance between the current and expected values in blood pressure either for total or group stratification. The absence of statistical effect might be due to sample size as our sources only allowed us to work with aggregated data. Key messages Quality and access to data is needed to assess impact of policies. to increase effects in blood pressure either salt reduction from bread must be larger or a wider range of products should be considered.

Abstract 14036: Enhanced External Counterpulsation Reduces Blood Pressure in Patients With Chronic Stable Angina: A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bradley Williams ◽  
Mehak Aggarwal ◽  
Cole Kiser ◽  
Krishnaswami Vijayaraghavan ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Stable Angina ◽  
Meta Analysis ◽  
Chronic Stable Angina ◽  
External Counterpulsation ◽  
Statistical Heterogeneity ◽  
The Impact ◽  
Enhanced External Counterpulsation

Background: Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP ® ) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP ® therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP ® therapy. Methods: A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP ® in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP ® (administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I 2 statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity. Results: We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP ® treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I 2 =87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I 2 =38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I 2 =70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I 2 =25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33). Conclusion: EECP ® treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP ® provide additional hypertension control in patients with chronic stable angina.

Exercise and Resting Blood Pressure in Children and Adolescents: A Meta-Analysis

2003 ◽  
Vol 15 (1) ◽  
pp. 83-97 ◽  
Author(s):  
George A. Kelley ◽  
Kristi S. Kelley
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Controlled Trials ◽  
Children And Adolescents ◽  
Diastolic Blood Pressure ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Resting Blood Pressure ◽  
Initial Blood Pressure

The purpose of this study was to use the meta-analytic approach to examine the effects of exercise on resting systolic and diastolic blood pressure in children and adolescents. Twenty-five studies that included 84 groups (45 exercise, 39 control) and 3,189 subjects (1,885 exercise, 1,304 control) met the criteria for inclusion. Using a random effects model, non-significant decreases of approximately 2% were found for resting systolic (mean – SEM, –2 – 1 mmHg, 95% CI, –4 to 1 mmHg) and diastolic (mean – SEM, –1 – 1 mmHg, 95% CI, –3 to 1 mmHg) blood pressure. Greater decreases in resting systolic blood pressure were found for nonrandomized versus randomized controlled trials (p = 0.001). There was also a statistically significant association between changes in resting systolic blood pressure and initial blood pressure (r = 0.73, p < 0.001) and body weight (r = 0.64, p < 0.001). However, when limited to randomized trials, these results were no longer statistically significant. The results of this study suggest that exercise does not reduce resting systolic and diastolic blood pressure in children and adolescents. However, a need exists for additional randomized controlled trials, especially among hypertensive children and adolescents.

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