A government-led, population-based strategy was successful at reducing dietary sodium intake and achieving a significant reduction in blood pressure in a large cohort in China, according to the results of a study published April 27 in JAMA Internal Medicine.

The Shandong–Ministry of Health Action on Salt and Hypertension (SMASH) multisectoral collaborative program consisted of a media campaign and distribution of scaled salt spoons, along with promotion of low-sodium products in markets and restaurants, and public education activities targeting reduction of sodium at home and at school.

Two cross-sectional surveys representative of the population conducted: one preintervention survey in in 2011 with 15,350 participants (50% women; mean age 40.7 years) and one postintervention survey in 2016 with 16,490 participants (50% women, mean age 42.8 years). The primary outcomes was change in urinary sodium excretion.

In-person interviews were conducted by trained interviewers to assess knowledge, attitudes and beliefs about dietary sodium intake and hypertension, and physical examinations were also conducted.

Researchers found that from 2011 to 2016, in the patients in whom 24-hour measurements were made, there was a 25% decrease in 24-hour urinary sodium excretion (from 5,338 mg/ day to 4,013 mg/day) and a 15% increase in potassium (from 1,607 mg/ day to 1,850 mg/day) (p<0.001 for both).

Adjusted mean systolic blood pressure decreased from 131.8 mm Hg to 130.0 mm Hg (p=0.04), and diastolic blood pressure decreased from 83.9 mm Hg to 80.8 mm Hg (p<0.001). There was also significant improvement in knowledge, attitudes and behaviors associated with dietary sodium reduction and hypertension.

The researchers noted the large sample size, high participation rates and 24-hour urine samples as strengths of the study, but noted the lack of a control group and statistical differences in the demographics across the years were limitations.

"The SMASH program showed that a comprehensive, population-based intervention with strong government support was associated with a substantial decrease in urinary sodium excretion and a modest reduction in BP," researchers concluded.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Hypertension

Keywords: Blood Pressure, Sodium, Dietary, Sodium, Potassium, Cross-Sectional Studies, Diet, Sodium-Restricted, Sodium Chloride, Dietary, Hypertension

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