Salt substitutes help to maintain healthy blood pressure in older adults

The replacement of regular salt with a salt substitute can reduce incidence of hypertension, or high blood pressure, in older adults without increasing their risk of low blood pressure episodes, according to a recent study in the Journal of the American College of Cardiology. People who used a salt substitute had a 40% lower incidence and likelihood of experiencing hypertension compared to those who used regular salt.

According to the World Health Organization, hypertension is the leading risk factor for cardiovascular disease and mortality.

It affects over 1.4 billion adults and results in 10.8 million deaths per year worldwide.

One of the most effective ways to reduce hypertension risk is to reduce sodium intake.

This study looks at salt substitutes as a better solution to control and maintain healthy blood pressure than reducing salt alone.

"Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods," said Yangfeng Wu, MD, PhD, lead author of the study and Executive Director of Peking University Clinical Research Institute in Beijing, China.

"It's crucial to recognize the impact of our dietary choices on heart health and increase the public's awareness of lower-sodium options."

Researchers in this study evaluated the impact of sodium reduction strategies on blood pressure in elderly adults residing in care facilities in China.

While previous studies prove that reducing salt intake can prevent or delay new-onset hypertension, long-term salt reduction and avoidance can be challenging.

The DECIDE-Salt study included 611 participants 55 years or older from 48 care facilities split into two groups: 24 facilities (313 participants) replacing usual salt with the salt substitute and 24 facilities (298 participants) continuing the use of usual salt.

All participants had blood pressure <140/90mmHg and were not using anti-hypertension medications at baseline.

The primary outcome was participants who had incident hypertension, initiated anti-hypertension medications or developed major cardiovascular adverse events during follow-up.

At two years, the incidence of hypertension was 11.7 per 100 people-years in participants with salt substitute and 24.3 per 100 people-years in participants with regular salt.

People using the salt substitute were 40% less likely to develop hypertension compared to those using regular salt.

Furthermore, the salt substitutes did not cause hypotension, which can be a common issue in older adults.

"Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals," Wu said.

"Considering its blood pressure -- lowering effect, proven in previous studies, the salt substitute shows beneficial to all people, either hypertensive or normotensive, thus a desirable population strategy for prevention and control of hypertension and cardiovascular disease."

Limitations of the study include that it is a post-hoc analysis, study outcomes were not pre-specified and there was a loss of follow-up visits in many patients.

Analyses indicated that these missing values were at random, and multiple sensitivity analyses supports the robustness of the results.

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Routinely drinking alcohol may raise blood pressure even in adults without hypertension

Even in adults without hypertension, blood pressure readings may climb more steeply over the years as the number of daily alcoholic drinks rise, according to an analysis of seven international research studies published today in Hypertension, an American Heart Association journal.

With the statistical power of seven international research studies, this analysis confirms for the first time there was a continuous increase in blood pressure measures in both participants with low and high alcohol intake. Even low levels of alcohol consumption were associated with detectable increases in blood pressure levels that may lead to a higher risk of cardiovascular events.

"We found no beneficial effects in adults who drank a low level of alcohol compared to those who did not drink alcohol," said senior study author Marco Vinceti, M.D., Ph.D., a professor of epidemiology and public health in the Medical School of the University of Modena and Reggio Emilia University in Italy and an adjunct professor in the department of epidemiology at Boston University's School of Public Health. "We were somewhat surprised to see that consuming an already-low level of alcohol was also linked to higher blood pressure changes over time compared to no consumption -- although far less than the blood pressure increase seen in heavy drinkers."

"Our analysis was based on grams of alcohol consumed and not just on the number of drinks to avoid the bias that might arise from the different amount of alcohol contained in 'standard drinks' across countries and/or types of beverages," said study co-author Tommaso Filippini, M.D., Ph.D., an associate professor of epidemiology and public health in the Medical School of the University of Modena and Reggio Emilia in Italy, and affiliate researcher at the University of California Berkeley School of Public Health.

Researchers reviewed the health data for all participants across the seven studies for more than five years. They compared adults who drank alcohol regularly with non-drinkers and found:
 

• Systolic (top number) blood pressure rose 1.25 millimeters of mercury (mm Hg) in people who consumed an average of 12 grams of alcohol per day, rising to 4.9 mm Hg in people consuming an average of 48 grams of alcohol per day. (In the U.S., 12 ounces of regular beer, 5 ounces of wine or a 1.5 ounce shot of distilled spirits contains about 14 grams of alcohol. Usual alcohol content differs in alcohol available in other countries.)
• Diastolic (bottom number) blood pressure rose 1.14 mm Hg in people consuming an average of 12 grams of alcohol per day, rising to 3.1 mm Hg in people consuming an average of 48 grams of alcohol per day. These associations were seen in males but not in females. Diastolic blood pressure measures the force against artery walls between heartbeats and is not as strong a predictor of heart disease risk in comparison to systolic.

"Alcohol is certainly not the sole driver of increases in blood pressure; however, our findings confirm it contributes in a meaningful way. Limiting alcohol intake is advised, and avoiding it is even better," Vinceti said.

Although none of the participants had high blood pressure when they enrolled in the studies, their blood pressure measurements at the beginning did have an impact on the alcohol findings.

"We found participants with higher starting blood pressure readings, had a stronger link between alcohol intake and blood pressure changes over time. This suggests that people with a trend towards increased (although still not "high") blood pressure may benefit the most from low to no alcohol consumption," said study co-author Paul K. Whelton, M.D., M.Sc., the Show Chwan Chair in Global Public Health in the department of epidemiology at Tulane University's School of Public Health and Tropical Medicine in New Orleans and president of the World Hypertension League. Whelton is also the chair of the American Heart Association's 2017 Hypertension Practice Guidelines and a member of the writing committee for the Association's 2021 Scientific Statement on Management of Stage 1 Hypertension in Adults.

According to American Heart Association recommendations, if you don't drink already, don't start. If you do drink, talk with your doctor about the benefits and risks of consuming alcohol in moderation. The Association also does not recommend drinking any form of alcohol to gain potential health benefits. Instead, follow the Association's lifestyle and health metrics for optimal cardiovascular health called Life's Essential 8: eat healthy food, be physically active, don't smoke, get enough sleep, maintain a healthy weight, and control cholesterol, blood sugar and blood pressure levels.

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How measuring blood pressure in both arms can help reduce cardiovascular risk and hypertension

Blood pressure should be measured in both arms and the higher reading should be adopted to improve hypertension diagnosis and management, according to a new study.

The research, led by University of Exeter, analysed data from 53,172 participants in 23 studies worldwide to examine the implications of choosing the higher or lower arm pressure.

The study, published in Hypertension, found that using the higher arm blood pressure reading reclassified 12 per cent of people as having hypertension, who would have fallen below the threshold for diagnosis if the lower reading arm was used.

Although International guidelines advise checking blood pressure in both arms, the practice is currently not widely adopted in clinics.

Study lead Dr Christopher Clark, from the University of Exeter, said: "High blood pressure is a global issue and poor management can be fatal. This study shows that failure to measure both arms and use the higher reading arm will not only result in underdiagnosis and undertreatment of high blood pressure but also under-estimation of cardiovascular risks for millions of people worldwide."

The team found that using the higher arm measurement compared to using the lower arm resulted in reclassification of 6572 (12.4%) of participants' systolic blood pressures from below to above 130 mm Hg, and 6339 (11.9%) from below to above 140 mm Hg, moving them above commonly used diagnostic thresholds for hypertension.

Dr Clark continued: "It's impossible to predict the best arm for blood pressure measurement as some people have a higher reading in their left arm compared to right and equal numbers have the opposite. Therefore, it's important to check both arms as detecting high blood pressure correctly is a vital step towards giving the right treatment to the right people."

"Our study now provides the first evidence that the higher reading arm blood pressure is the better predictor of future cardiovascular risk."

The study also revealed that higher arm blood pressure readings better predicted all-cause mortality, cardiovascular mortality, and cardiovascular events, compared to the lower arm reading. The authors stressed the importance of assessing both arms in the diagnosis and management of hypertension and cardiovascular diseases.

From Science Daily