Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 34, Issue 4, Pages 414-425Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpaa176
Keywords
blood pressure; hypertension; intracerebral hemorrhage; ischemic stroke; potassium; sodium; stroke
Categories
Funding
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Canada
- Canadian Stroke Network
- Swedish Research Council
- Swedish Heart and Lung Foundation
- Health & Medical Care Committee of the Regional Executive Board
- Astra Zeneca
- Boehringer Ingelheim (Canada)
- Pfizer (Canada)
- MERCK
- Sharp and Dohme
- UK Heart and Stroke
- Wellcome TrustHealth Research Board Irish Clinical Academic Training (ICAT)
- European Research Council COSIP Grant [640580]
- Region Vastra Gotaland
- UK Chest
- European Research Council (ERC) [640580] Funding Source: European Research Council (ERC)
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This study showed that both high and low urinary sodium excretion were associated with increased risk of stroke, with high sodium intake being a stronger risk factor for intracerebral hemorrhage than ischemic stroke. Urinary potassium levels were inversely and linearly associated with stroke risk, especially for ischemic stroke. The combination of moderate sodium intake and high potassium intake was associated with the lowest risk of stroke.
BACKGROUND Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS Compared with an estimated urinary sodium excretion of 2.8-3.5 g/ day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake-rather than low sodium intake-combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
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