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dc.contributor.authorHuang, Len_US
dc.contributor.authorTrieu, Ken_US
dc.contributor.authorYoshimura, Sen_US
dc.contributor.authorNeal, Ben_US
dc.contributor.authorWoodward, Men_US
dc.contributor.authorCampbell, NRCen_US
dc.contributor.authorLi, Qen_US
dc.contributor.authorLackland, DTen_US
dc.contributor.authorLeung, AAen_US
dc.contributor.authorAnderson, CAMen_US
dc.contributor.authorMacGregor, GAen_US
dc.contributor.authorHe, FJen_US
dc.date.accessioned2020-03-16T12:15:59Z
dc.date.available2019-12-24en_US
dc.date.issued2020-02-24en_US
dc.identifier.urihttps://qmro.qmul.ac.uk/xmlui/handle/123456789/63179
dc.description.abstractOBJECTIVE: To examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration. DESIGN: Systematic review and meta-analysis following PRISMA guidelines. DATA SOURCES: Ovid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019. INCLUSION CRITERIA: Randomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion. DATA EXTRACTION AND ANALYSIS: Two of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression. RESULTS: 133 studies with 12 197 participants were included. The mean reductions (reduced sodium v usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P<0.001), 4.26 mm Hg (3.62 to 4.89, P<0.001), and 2.07 mm Hg (1.67 to 2.48, P<0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days' duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction. CONCLUSIONS: The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019140812.en_US
dc.format.extentm315 - ?en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofBMJen_US
dc.rightsCreative Commons Attribution (CC BY 4.0) license
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectBlood Pressureen_US
dc.subjectBlood Pressure Determinationen_US
dc.subjectDiet, Sodium-Restricteden_US
dc.subjectDose-Response Relationship, Drugen_US
dc.subjectHumansen_US
dc.subjectHypertensionen_US
dc.subjectRandomized Controlled Trials as Topicen_US
dc.subjectSodium Chloride, Dietaryen_US
dc.titleEffect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials.en_US
dc.typeArticle
dc.identifier.doi10.1136/bmj.m315en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/32094151en_US
pubs.notesNot knownen_US
pubs.publication-statusPublished onlineen_US
pubs.volume368en_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
rioxxterms.funder.project483cf8e1-88a1-4b8b-aecb-8402672d45f8en_US


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