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Background: Although meta-analyses of randomized controlled trials (RCTs) of salt reduction report a reduction in the level of blood pressure (BP), the effect of reduced dietary salt on cardiovascular disease (CVD) events remains unclear.
Methods: We searched for RCTs with follow-up of at least 6 months that compared dietary salt reduction (restricted salt dietary intervention or advice to reduce salt intake) to control/no intervention in adults, and reported mortality or CVD morbidity data. Outcomes were pooled at end of trial or longest follow-up point.
Results: Seven studies were identified: three in normotensives, two in hypertensives, one in a mixed population of normo- and hypertensives and one in heart failure. Salt reduction was associated with reductions in urinary salt excretion of between 27 and 39 mmol/24 h and reductions in systolic BP between 1 and 4 mm Hg. Relative risks (RRs) for all-cause mortality in normotensives and hypertensives showed no strong evidence of any effect of salt reduction CVD morbidity in people with normal BP and raised BP at baseline also showed no strong evidence of benefit. Salt restriction increased the risk of all-cause mortality in those with heart failure.
Our finding of a lack of strong evidence of an effect of dietary sodium reduction on mortality and CVD outcomes is in contrast to those of Strazzullo and colleagues, who systematically reviewed prospective observational studies that examined the relationship between dietary sodium and all-cause mortality and CVD mortality