Association of urinary sodium and potassium excretion with blood pressure.

Andrew Mente, Martin J. O'Donnell, Sumathy Rangarajan, Matthew J. McQueen, Paul Poirier, Andreas Wielgosz, Howard Morrison, Wei Li, Xingyu Wang, Chen Di, Prem Mony, Anitha Devanath, Annika Rosengren, Aytekin Oguz, Katarzyna Zatonska, Afzal Hussein Yusufali, Patricio Lopez-Jaramillo, Alvaro Avezum, Noor Hassim Ismail, Fernando LanasThandi Puoane, Rafael Diaz, Roya Kelishadi, Romaina Iqbal, Rita Yusuf, Jephat Chifamba, Rasha Khatib, Koon Teo, Salim Yusuf, Investigators PURE Investigators

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Abstract

Higher levels of sodium intake are reported to be associated with higher blood pressure. Whether this relationship varies according to levels of sodium or potassium intake and in different populations is unknown. We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device. Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion. The slope of this association was steeper with higher sodium intake (an increment of 2.58 mm Hg in systolic blood pressure per gram for sodium excretion >5 g per day, 1.74 mm Hg per gram for 3 to 5 g per day, and 0.74 mm Hg per gram for <3 g per day; P<0.001 for interaction). The slope of association was steeper for persons with hypertension (2.49 mm Hg per gram) than for those without hypertension (1.30 mm Hg per gram, P<0.001 for interaction) and was steeper with increased age (2.97 mm Hg per gram at >55 years of age, 2.43 mm Hg per gram at 45 to 55 years of age, and 1.96 mm Hg per gram at <45 years of age; P<0.001 for interaction). Potassium excretion was inversely associated with systolic blood pressure, with a steeper slope of association for persons with hypertension than for those without it (P<0.001) and a steeper slope with increased age (P<0.001). In this study, the association of estimated intake of sodium and potassium, as determined from measurements of excretion of these cations, with blood pressure was nonlinear and was most pronounced in persons consuming high-sodium diets, persons with hypertension, and older persons. (Funded by the Heart and Stroke Foundation of Ontario and others.).

Original languageEnglish
Pages (from-to)601-611
Number of pages11
JournalThe New England journal of medicine
Volume371
Issue number7
DOIs
Publication statusPublished - 2014

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Potassium
Sodium
Blood Pressure
Hypertension
Ontario
Electrolytes
Cations
Fasting
Stroke
Regression Analysis
Urine
Diet
Equipment and Supplies
Population

ASJC Scopus subject areas

  • Medicine(all)

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Mente, A., O'Donnell, M. J., Rangarajan, S., McQueen, M. J., Poirier, P., Wielgosz, A., ... PURE Investigators, I. (2014). Association of urinary sodium and potassium excretion with blood pressure. The New England journal of medicine, 371(7), 601-611. https://doi.org/10.1056/NEJMoa1311989

Association of urinary sodium and potassium excretion with blood pressure. / Mente, Andrew; O'Donnell, Martin J.; Rangarajan, Sumathy; McQueen, Matthew J.; Poirier, Paul; Wielgosz, Andreas; Morrison, Howard; Li, Wei; Wang, Xingyu; Di, Chen; Mony, Prem; Devanath, Anitha; Rosengren, Annika; Oguz, Aytekin; Zatonska, Katarzyna; Yusufali, Afzal Hussein; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Ismail, Noor Hassim; Lanas, Fernando; Puoane, Thandi; Diaz, Rafael; Kelishadi, Roya; Iqbal, Romaina; Yusuf, Rita; Chifamba, Jephat; Khatib, Rasha; Teo, Koon; Yusuf, Salim; PURE Investigators, Investigators.

In: The New England journal of medicine, Vol. 371, No. 7, 2014, p. 601-611.

Research output: Contribution to journalArticle

Mente, A, O'Donnell, MJ, Rangarajan, S, McQueen, MJ, Poirier, P, Wielgosz, A, Morrison, H, Li, W, Wang, X, Di, C, Mony, P, Devanath, A, Rosengren, A, Oguz, A, Zatonska, K, Yusufali, AH, Lopez-Jaramillo, P, Avezum, A, Ismail, NH, Lanas, F, Puoane, T, Diaz, R, Kelishadi, R, Iqbal, R, Yusuf, R, Chifamba, J, Khatib, R, Teo, K, Yusuf, S & PURE Investigators, I 2014, 'Association of urinary sodium and potassium excretion with blood pressure.', The New England journal of medicine, vol. 371, no. 7, pp. 601-611. https://doi.org/10.1056/NEJMoa1311989
Mente A, O'Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A et al. Association of urinary sodium and potassium excretion with blood pressure. The New England journal of medicine. 2014;371(7):601-611. https://doi.org/10.1056/NEJMoa1311989
Mente, Andrew ; O'Donnell, Martin J. ; Rangarajan, Sumathy ; McQueen, Matthew J. ; Poirier, Paul ; Wielgosz, Andreas ; Morrison, Howard ; Li, Wei ; Wang, Xingyu ; Di, Chen ; Mony, Prem ; Devanath, Anitha ; Rosengren, Annika ; Oguz, Aytekin ; Zatonska, Katarzyna ; Yusufali, Afzal Hussein ; Lopez-Jaramillo, Patricio ; Avezum, Alvaro ; Ismail, Noor Hassim ; Lanas, Fernando ; Puoane, Thandi ; Diaz, Rafael ; Kelishadi, Roya ; Iqbal, Romaina ; Yusuf, Rita ; Chifamba, Jephat ; Khatib, Rasha ; Teo, Koon ; Yusuf, Salim ; PURE Investigators, Investigators. / Association of urinary sodium and potassium excretion with blood pressure. In: The New England journal of medicine. 2014 ; Vol. 371, No. 7. pp. 601-611.
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AU - Di, Chen

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AU - Puoane, Thandi

AU - Diaz, Rafael

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