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Dietary Sodium Salt Intake In Hypertension

Reducing sodium salt intake in hypertensive patients is one of the nutritional interventions carried out to control blood pressure. Studies show that not everyone has the same response to the regulation of salt diets to control blood pressure, so various factors need to be considered in recommending a sodium salt diet in hypertensive patients.

For millions of years ago, ancient humans consumed salt only from meat and vegetables, which made them consume less than 1 gram of salt per day. Along with the times, an increase in consumption of foods processed using salt, so that the average modern human consumes 9-12 grams of salt per day. As a result, diseases caused by excessive salt intake begin to increase, one of which is hypertension.


Relationship of Sodium Salt with Hypertension


The sodium salt, or also known as sodium chloride (NaCl), contains 40% sodium and 60% chloride. It works as an electrolyte that affects the physiological functions of the muscles and nerves, plays the roles in the active transport of cell membranes, and in blood pressure control. Lack of sodium salt intake can trigger insulin resistance, affect fat blood levels, and increase plasma renin activity. Conversely, excess sodium salt intake can increase blood pressure, which increases the risks of cardiovascular diseases and kidney diseases.

The sodium salt's role in the occurrence of hypertension involves several factors, including neurohormonal, genetic, environmental, and metabolic factors. However, the mechanism that is widely believed to link the sodium salt intake with increased blood pressure is the increased renal sodium retention. Sodium salt acts as a regulator of fluid balance in the body. Increased sodium salt intake will cause sodium and water retention in the kidney that leads to increased blood pressure. High intake of sodium salt also causes arterial baroreceptor denervation, renal afferent nerve interruption, and vascular reactivity.

Some genetic phenotypes have the sensitivity to sodium salt. Patients with this genetic disposition experience an increase in blood pressure> 7 mmHg when consuming a diet high sodium salt compared to low sodium salt. However, this is still in the research stage, so genetic markers are not yet available for use in clinical settings.

Sodium Salt Diet Recommendations


Each country has different references regarding the amount of daily sodium intake. The 2015-2020 Dietary Guideline for Americans recommends consuming sodium salt for adults to be limited to <2.3 grams per day.

WHO recommends consuming sodium salt about <2 grams for adults. However, at this time, the amount of sodium salt intake in various countries around the world, reportedly almost double the amount recommended by WHO, which is 3.95 grams per day. The highest amount of sodium salt consumption is found in the Asian continent, which is around 5.51 grams per day.

People with hypertension should work together with nutritionists to develop the best diet for them. In general, the diets program that is often recommended for people with hypertension is Dietary Approaches to Stop Hypertension (DASH). This diet encourages consuming fruits, vegetables, and certain types of grains, compared to eating foods high in saturated fat, products with artificial sweeteners, and foods with high sugar content. Other recommended foods are low-fat or fat-free products, such as fish, nuts, and vegetable oils.

According to the DASH program, sodium salt consumption is recommended <2.3 grams per day to control blood pressure. The results showed that this type of diet compared with controls (high sodium diet) resulted in a decrease in blood pressure of 7.1 mmHg in subjects without hypertension, and a decrease in blood pressure of 11.5 mmHg in subjects with hypertension.


References
1. Dong OM. Excessive Dietary Sodium Intake and Elevated Blood Pressure: A Review of Current Prevention and Management Strategies and The Emerging Role of Pharmaconutrigenetics. BMJNPH. 2018; 0: p. 1–10. downloaded from https://nutrition.bmj.com/content/early/2018/10/05/bmjnph-2018-000004.
2. Ha SK. Dietary Salt Intake and Hypertension. Electrolyte Blood Press. 2014; 12: p. 7-18. downloaded from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105387/
3. Frisoli TM, Schmieder RE, et al. Salt and Hypertension: Is Salt Dietary Reduction Worth the Effort?. The American Journal of Medicine. 2012; 125: p. 433-9. downloaded from https://www.amjmed.com/article/S0002-9343(11)00949-1/fulltext




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