National Academies Press: OpenBook

Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005)

Chapter: Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure

« Previous: Appendix H: U.S. Total Water Intake Data by Frequency of Leisure Time Activity from the Third National Health and Nutrition Examination Survey, 1988–1994
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

I
Dose-Response Effects of Sodium Intake on Blood Pressure

FIGURE I-1 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 8 normotensive men and women. Each sodium level was provided for 5 d. NS = not significantly different. Data from Roos et al. (1985).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-2 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 6 normotensive subjects at risk of hypertension. Each sodium level was provided for 4 d. Systolic blood pressures were calculated from the formula mean blood pressure = 2/3 diastolic blood pressure + 1/3 systolic blood pressure. NS = not significantly different; *p < 0.001; **p < 0.05. Data from Sullivan et al. (1980).

FIGURE I-3 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 14 normotensive men. Each sodium level was provided for 3–7 d. Significant difference between 10 and 800 mmol/d (p < 0.05). Data from Luft et al. (1979).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-4 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 11 normotensive men and women with a family history of hypertension. Each sodium level was provided for 9 d. NS = not significantly different. Data from Fuchs et al. (1987).

FIGURE I-5 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 6 normotensive men and women without family history of hypertension. Each sodium level was provided for 9 d. NS = not significantly different. Data from Fuchs et al. (1987).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-6 Mean supine blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 8 normotensive men. Each sodium level was provided for 4 wk. NS = not significantly different. Data from Kirkendall et al. (1976).

FIGURE I-7 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 10 normotensive men and women. Each sodium level was provided for 4 d. NS = not significantly different. Data from Bruun et al. (1990).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-8 Blood pressure (mm Hg) according to sodium intake in g/d (mmol/d) among 17 normotensive elderly subjects. Each sodium level was provided for 2 wk. *P-ANOVA simultaneously comparing the four pair-wise blood pressure differences between the lowest sodium level (baseline) and each of the four higher sodium levels. Data from Johnson et al. (2001).

FIGURE I-9 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 12 hypertensive men and women. Each sodium level was provided for 4 d. NS = not significantly different. Data from Bruun et al. (1990).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-10 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 61 hypertensive men. Each sodium level was provided for 2 wk. NS = not significantly different; *p < 0.05. Data from Ferri et al. (1996).

FIGURE I-11 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 20 hypertensive men and women. Each sodium level was provided for 4 wk. *p < 0.01. Data from MacGregor et al. (1989).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-12 Blood pressure (mm Hg) according to sodium intake in g/d (mmol/ d) among 8 systolic diastolic hypertensive elderly subjects. Each sodium level was provided for 2 wk. *P-ANOVA simultaneously comparing the four pair-wise blood pressure differences between the lowest sodium level (baseline) and each of the four higher sodium levels. Data from Johnson et al. (2001).

FIGURE I-13 Blood pressure (mm Hg) according to sodium dose in g/d (mmol/ d) among 15 isolated systolic hypertensive elderly subjects. Each sodium dose was provided for 2 wk. *P-ANOVA simultaneously comparing the four pair-wise blood pressure differences between the lowest sodium level (baseline) and each of the four higher sodium levels. Data from Johnson et al. (2001).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

FIGURE I-14 Analyses from the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial: Effect of sodium level on systolic and diastolic blood pressure in 412 normotensives and hypertensive participants. Sodium levels defined as higher = 3.5 g/d/2,000 kcal (150 mmol/d), intermediate = 2.3 g/d/2,000 kcal (100 mmol/d), and lower = 1.2 g/d/2,000 kcal (50 mmol/d). Adapted with permission from Sacks et al. (2001). Copyright 2001 by the Massachusetts Medical Society.

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

TABLE I-1a Mean Blood Pressure by Diet and by Sodium Level, Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial

Diet

Systolic

Diastolic

Higher

Intermediate

Lower

Higher

Intermediate

Lower

Control diet (n = 204)

132.8

130.7

126.1

83.4

82.3

79.9

DASH diet (n = 208)

126.9

125.6

123.9

80.5

79.9

78.9

SOURCE: Sacks et al. (2001).

TABLE I-1b Effect of Decreased Sodium on Systolic and Diastolic Blood Pressure, Control Diet (n = 204) in DASH-Sodium Trial

 

Systolic

Diastolic

Mean Change

Standard Error

P-value

Mean Change

Standard Error

P-value

Higher to lower

−6.7

0.58

< 0.0001

−3.5

0.38

< 0.0001

Higher to intermediate

−2.1

0.58

0.0003

−1.1

0.38

0.0044

Intermediate to lower

−4.6

0.60

< 0.0001

−2.4

0.39

< 0.0001

SOURCE: Sacks et al. (2001).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

TABLE I-1c Effect of Decreased Sodium on Systolic and Diastolic Blood Pressure, DASH Diet (n = 208), in DASH-Sodium Trial

 

Systolic

Diastolic

Mean Change

Standard Error

P-value

Mean Change

Standard Error

P-value

Higher to lower

−3.0

0.58

< 0.0001

−1.6

0.37

< 0.0001

Higher to intermediate

−1.3

0.58

0.03

−0.6

0.37

0.09

Intermediate to lower

−1.7

0.59

0.003

−1.0

0.38

0.01

SOURCE: Sacks et al. (2001).

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

TABLE I-2 Design Features of Dose-Response Trials that Tested the Effects of Sodium Intake on Blood Pressure

Study

Figure (Appendix I)

Reference

N

Nonhypertensive

1

1

Roos et al. (1985)

8

2

2

Sullivan et al. (1980)

6

3

3

Luft et al. (1979)

14

4

4

Fuchs et al. (1987), at risk of hypertension

17

 

5

Fuchs et al. (1987), not at risk of hypertension

17

5

6

Kirkendall et al. (1976)

8

6

7

Bruun et al. (1990)

10

7

8

Johnson et al. (2001)

17

Hypertensive

 

9

Bruun et al. (1990)

12

8

10

Ferri et al. (1996)

61

9

11

MacGregor et al. (1989)

20

 

12

Johnson et al. (2001), systolic-diastolic hypertension

8

 

13

Johnson et al. (2001), isolated systolic hypertension

15

Both nonhypertensive and hypertensive

10

14

Sacks et al. (2001) DASHc diet Control diet 204

208

a Urinary sodium.

b Urinary potassium.

c DASH = Dietary Approaches to Stop Hypertension.

REFERENCES

Bruun NE, Skott P, Nielsen MD, Rasmussen S, Schutten HJ, Leth A, Pedersen EB, Giese J. 1990. Normal renal tubular response to changes of sodium intake in hypertensive man. J Hypertens 8:219–227.


Ferri C, Bellini C, Carlomagno A, Desideri G, Santucci A. 1996. Active kallikrein response to changes in sodium-chloride intake in essential hypertensive patients. J Am Soc Nephrol 7:443–453.

Fuchs FD, Wannmacher CM, Wannmacher L, Guimaraes FS, Rosito GA, Gastaldo G, Hoeffel CP, Wagner EM. 1987. Effect of sodium intake on blood pressure, serum levels and renal excretion of sodium and potassium in normotensives with and without familial predisposition to hypertension. Braz J Med Biol Res 20:25–34.


Johnson AG, Nguyen TV, Davis D. 2001. Blood pressure is linked to salt intake and modulated by the angiotensinogen gene in normotensive and hypertensive elderly subjects. J Hypertens 19:1053–1060.


Kirkendall WM, Conner EW, Abboud F, Rastogi SP, Anderson TA, Fry M. 1976. The effect of dietary sodium chloride on blood pressure, body fluids, electro-

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×

Duration (days)

Feeding Study

Design

Range of Sodium g/d (mmol/d)

Potassium Level g/d (mmol/d)

Lowest

Highest

5

Yes

Dose-escalation

0.46 (20)

25.9 (1,128)

3.1 (80)

4

Yes

Crossover

0.23 (10)

9.2 (400)

2.3 (60)

3–7

Yes

Dose-escalation

0.23 (10)

34.5 (1,500)

3.1 (80)

9

No

Crossover

3.7 (16)a

5.5 (239)a

≈ 1.9 (50)b

9

No

Crossover

0.18 (8)a

5.6 (245)a

≈ 1.9 (50)b

28

Yes

Crossover

0.23 (10)

9.4 (410)

3.9 (100)

4

Yes

Crossover

1.2 (50)

8.7 (380)

3.1 (80)

14

Yes

Crossover

0.92 (40)

7.8 (340)

≈ 1.2 (30)b

4

Yes

Crossover

1.2 (50)

8.7 (380)

3.1 (80)

14

Yes

Crossover

0.46 (20)

7.4 (320)

2.7 (70)

28

No

Crossover

1.2 (50)

4.6 (200)

2.7 (70)

14

Yes

Crossover

0.92 (40)

7.8 (340)

≈ 1.2 (30)b

14

Yes

Crossover

0.92 (40)

7.8 (340)

≈ 1.2 (30)b

28

Yes

Crossover

1.5 (67)a

3.3 (144)

3.1 (79)b

28

Yes

Crossover

1.5 (64)a

3.2 (141)a

1.6 (41)b

lytes, renal function, and serum lipids of normotensive man. J Lab Clin Med 87:418–434.


Luft FC, Rankin LI, Bloch R, Weyman AE, Willis LR, Murray RH, Grim CE, Weinberger MH. 1979. Cardiovascular and humoral responses to extremes of sodium intake in normal black and white men. Circulation 60:697–706.


MacGregor GA, Markandu ND, Sagnella GA, Singer DRJ, Cappuccio FP. 1989. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet 2:1244–1247.


Roos JC, Koomans HA, Dorhout-Mees EJ, Delawi IMK 1985. Renal sodium handling in normal humans subjected to low, normal, and extremely high sodium supplies. Am J Physiol 249:F941–F947.


Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH. 2001. Effects of blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 344:3–10.

Sullivan JM, Ratts TE, Taylor JC, Kraus DH, Barton BR, Patrick DR, Reed SW. 1980. Hemodynamic effects of dietary sodium in man. Hypertension 2:506–514.

Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 546
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 547
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 548
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 549
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 550
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 551
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 552
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 553
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 554
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 555
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 556
Suggested Citation:"Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure." Institute of Medicine. 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press. doi: 10.17226/10925.
×
Page 557
Next: Appendix J: Serum Electrolyte Concentrations NHANES III, 1988-94 »
Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate Get This Book
×

Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate The Dietary Reference Intakes (DRIs) are quantitative estimates of nutrient intakes to be used for planning and assessing diets for healthy people. This new report, the sixth in a series of reports presenting dietary reference values for the intakes of nutrients by Americans and Canadians, establishes nutrient recommendations on water, potassium, and salt for health maintenance and the reduction of chronic disease risk. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate discusses in detail the role of water, potassium, salt, chloride, and sulfate in human physiology and health. The major findings in this book include the establishment of Adequate Intakes for total water (drinking water, beverages, and food), potassium, sodium, and chloride and the establishment of Tolerable Upper Intake levels for sodium and chloride. The book makes research recommendations for information needed to advance the understanding of human requirements for water and electrolytes, as well as adverse effects associated with the intake of excessive amounts of water, sodium, chloride, potassium, and sulfate. This book will be an invaluable reference for nutritionists, nutrition researchers, and food manufacturers.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!