Blood pressure and urinary sodium in men and women:: the Norfolk Cohort of the European Prospective Investigation into cancer (EPIC-Norfolk)1-3

Background: Abundant evidence indicates that a high sodium intake is causally related to high blood pressure, but debate over recommendations to reduce dietary sodium in the general population continues. A key issue is whether differences in usual sodium intake within the range feasible in free-living populations have clinical or public health relevance. Objective: We examined the relation between blood pressure and urinary sodium as a marker of dietary intake. Design: This was a study of 23 104 community-living adults aged 45-79 y. Results: Mean systolic and diastolic blood pressure increased as the ratio of urinary sodium to creatinine increased (as estimated from a casual urine sample), with differences of 7.2 mm Hg for systolic blood pressure and 3.0 mm Hg for diastolic blood pressure (P < 0.0001) between the top and bottom quintiles. This trend was independent of age, body mass index, urinary potassium: creatinine, and smoking and was consistent by sex and history of hypertension. The prevalence of those with systolic blood pressure greater than or equal to 160 mm Hg halved from 12% in the top quintile to 6% in the bottom quintile; the odds ratio for having systolic blood pressure greater than or equal to 160 mm Hg was 2.48 (95% CI: 1.90, 3.22) for men and 2.67 (95% CI: 2.08, 3.43) for women in the top compared with the bottom quintile of urinary sodium. Estimated mean sodium intakes in the lowest and highest quintiles were approximate to80 and 220 mmol/d. respectively. Conclusions: Within the usual range found in a free-living population, differences in urinary sodium, an indicator of dietary sodium intake. are associated with blood pressure differences of clinical and public health relevance. Our findings reinforce recommendations to lower average sodium intakes in the general population.