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Published in: Nutrition Journal 1/2011

Open Access 01-12-2011 | Research

Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure

Authors: Essi S Sarkkinen, Mika J Kastarinen, Tarja H Niskanen, Pia H Karjalainen, Taisa M Venäläinen, Jay K Udani, Leo K Niskanen

Published in: Nutrition Journal | Issue 1/2011

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Abstract

Background

High salt intake is linked to hypertension whereas a restriction of dietary salt lowers blood pressure (BP). Substituting potassium and/or magnesium salts for sodium chloride (NaCl) may enhance the feasibility of salt restriction and lower blood pressure beyond the sodium reduction alone. The aim of this study was to determine the feasibility and effect on blood pressure of replacing NaCl (Regular salt) with a novel mineral salt [50% sodium chloride and rich in potassium chloride (25%), magnesium ammonium potassium chloride, hydrate (25%)] (Smart Salt).

Methods

A randomized, double-blind, placebo-controlled study was conducted with an intervention period of 8-weeks in subjects (n = 45) with systolic (S)BP 130-159 mmHg and/or diastolic (D)BP 85-99 mmHg. During the intervention period, subjects consumed processed foods salted with either NaCl or Smart Salt. The primary endpoint was the change in SBP. Secondary endpoints were changes in DBP, daily urine excretion of sodium (24-h dU-Na), potassium (dU-K) and magnesium (dU-Mg).

Results

24-h dU-Na decreased significantly in the Smart Salt group (-29.8 mmol; p = 0.012) and remained unchanged in the control group: resulting in a 3.3 g difference in NaCl intake between the groups. Replacement of NaCl with Smart Salt resulted in a significant reduction in SBP over 8 weeks (-7.5 mmHg; p = 0.016). SBP increased (+3.8 mmHg, p = 0.072) slightly in the Regular salt group. The difference in the change of SBP between study groups was significant (p < 0.002).

Conclusions

The substitution of Smart Salt for Regular salt in subjects with high normal or mildly elevated BP resulted in a significant reduction in their daily sodium intake as well as a reduction in SBP.

Trial Registration

Appendix
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Literature
1.
go back to reference World Health Organization, International Society of Hypertension Writing Group: 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003, 21: 1983-1992.CrossRef World Health Organization, International Society of Hypertension Writing Group: 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003, 21: 1983-1992.CrossRef
2.
go back to reference Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ: Trends in hypertension prevalence, awareness, treatment and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008, 52: 818-27. 10.1161/HYPERTENSIONAHA.108.113357.CrossRefPubMed Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ: Trends in hypertension prevalence, awareness, treatment and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008, 52: 818-27. 10.1161/HYPERTENSIONAHA.108.113357.CrossRefPubMed
3.
go back to reference Kastarinen MJ, Antikainen RL, Peltonen M, Laatikainen T, Barengo NC, Jula A, et al: Prevalence, awareness and treatment of hypertension in Finland during 1982-2007. J Hypertens. 2009, 27: 1552-9. 10.1097/HJH.0b013e32832c41cd.CrossRefPubMed Kastarinen MJ, Antikainen RL, Peltonen M, Laatikainen T, Barengo NC, Jula A, et al: Prevalence, awareness and treatment of hypertension in Finland during 1982-2007. J Hypertens. 2009, 27: 1552-9. 10.1097/HJH.0b013e32832c41cd.CrossRefPubMed
4.
go back to reference Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al: Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001, 344: 3-10. 10.1056/NEJM200101043440101.CrossRefPubMed Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al: Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001, 344: 3-10. 10.1056/NEJM200101043440101.CrossRefPubMed
5.
go back to reference Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM: Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension. 2006, 47: 296-308.CrossRefPubMed Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM: Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension. 2006, 47: 296-308.CrossRefPubMed
6.
go back to reference Wexler R, Aukerman G: Nonpharmacologic strategies for managing hypertension. Am Fam Physician. 2006, 73: 1953-6.PubMed Wexler R, Aukerman G: Nonpharmacologic strategies for managing hypertension. Am Fam Physician. 2006, 73: 1953-6.PubMed
7.
go back to reference Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al: Projected effect of dietary salt reductions on future cardiovascular disease. New Engl J Med. 2010, 362: 590-9. 10.1056/NEJMoa0907355.CrossRefPubMedPubMedCentral Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al: Projected effect of dietary salt reductions on future cardiovascular disease. New Engl J Med. 2010, 362: 590-9. 10.1056/NEJMoa0907355.CrossRefPubMedPubMedCentral
8.
go back to reference Law MR, Frost CD, Wald NJ: By how much does dietary salt reduction lower blood pressure? III--Analysis of data from trials of salt reduction. BMJ. 1991, 302: 819-24. 10.1136/bmj.302.6780.819. Erratum in BMJ 302,939CrossRefPubMedPubMedCentral Law MR, Frost CD, Wald NJ: By how much does dietary salt reduction lower blood pressure? III--Analysis of data from trials of salt reduction. BMJ. 1991, 302: 819-24. 10.1136/bmj.302.6780.819. Erratum in BMJ 302,939CrossRefPubMedPubMedCentral
9.
go back to reference Midgley JP, Matthew AG, Greenwood CM, Logan AG: Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 1996, 275: 1590-7. 10.1001/jama.275.20.1590.CrossRefPubMed Midgley JP, Matthew AG, Greenwood CM, Logan AG: Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 1996, 275: 1590-7. 10.1001/jama.275.20.1590.CrossRefPubMed
10.
go back to reference Cutler JA, Follmann D, Allender PS: Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997, 65 (Suppl 2): 643S-651S.PubMed Cutler JA, Follmann D, Allender PS: Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997, 65 (Suppl 2): 643S-651S.PubMed
11.
go back to reference Graudal NA, Galløe AM, Garred P: Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998, 279: 1383-91. 10.1001/jama.279.17.1383.CrossRefPubMed Graudal NA, Galløe AM, Garred P: Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998, 279: 1383-91. 10.1001/jama.279.17.1383.CrossRefPubMed
12.
go back to reference Alam S, Johnson AG: A meta-analysis of randomised controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure. J Hum Hypertens. 1999, 13: 367-74. 10.1038/sj.jhh.1000817.CrossRefPubMed Alam S, Johnson AG: A meta-analysis of randomised controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure. J Hum Hypertens. 1999, 13: 367-74. 10.1038/sj.jhh.1000817.CrossRefPubMed
13.
go back to reference He FJ, MacGregor GA: Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002, 16: 761-70. 10.1038/sj.jhh.1001459.CrossRefPubMed He FJ, MacGregor GA: Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002, 16: 761-70. 10.1038/sj.jhh.1001459.CrossRefPubMed
14.
go back to reference He FJ, MacGregor GA: Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004, CD004937- He FJ, MacGregor GA: Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004, CD004937-
15.
go back to reference Jürgens G, Graudal NA: Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride. Cochrane Database Syst Rev. 2004, CD004022- Jürgens G, Graudal NA: Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride. Cochrane Database Syst Rev. 2004, CD004022-
16.
go back to reference Neutel J: Replacing regular salt with sodium-reduced potassium- and magnesium-enriched mineral salt may offer non-pharmacological approach to lowering blood pressure. Am J Hypertens. 1996, 9: 94A-10.1016/0895-7061(96)81769-9.CrossRef Neutel J: Replacing regular salt with sodium-reduced potassium- and magnesium-enriched mineral salt may offer non-pharmacological approach to lowering blood pressure. Am J Hypertens. 1996, 9: 94A-10.1016/0895-7061(96)81769-9.CrossRef
17.
go back to reference Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, et al: Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA. 1997, 277: 1624-32. 10.1001/jama.277.20.1624.CrossRefPubMed Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, et al: Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA. 1997, 277: 1624-32. 10.1001/jama.277.20.1624.CrossRefPubMed
19.
go back to reference Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ: The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens. 2002, 15: 691-6. 10.1016/S0895-7061(02)02964-3.CrossRefPubMed Jee SH, Miller ER, Guallar E, Singh VK, Appel LJ, Klag MJ: The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens. 2002, 15: 691-6. 10.1016/S0895-7061(02)02964-3.CrossRefPubMed
20.
go back to reference Karppanen H, Tanskanen A, Tuomilehto J, Puska P, Vuori J, Jäntti V, et al: Safety and effects of potassium- and magnesium-containing low sodium salt mixtures. J Cardiovasc Pharmacol. 1984, 6 (Suppl 1): S236-43.CrossRefPubMed Karppanen H, Tanskanen A, Tuomilehto J, Puska P, Vuori J, Jäntti V, et al: Safety and effects of potassium- and magnesium-containing low sodium salt mixtures. J Cardiovasc Pharmacol. 1984, 6 (Suppl 1): S236-43.CrossRefPubMed
21.
go back to reference Geleijnse JM, Witteman JC, Bak AA, den Breeijen JH, Grobbee DE: Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. BMJ. 1994, 309: 436-40.CrossRefPubMedPubMedCentral Geleijnse JM, Witteman JC, Bak AA, den Breeijen JH, Grobbee DE: Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. BMJ. 1994, 309: 436-40.CrossRefPubMedPubMedCentral
22.
go back to reference Omvik P, Myking OL: Unchanged central hemodynamics after six months of moderate sodium restriction with or without potassium supplement in essential hypertension. Blood Press. 1995, 4: 32-41. 10.3109/08037059509077565.CrossRefPubMed Omvik P, Myking OL: Unchanged central hemodynamics after six months of moderate sodium restriction with or without potassium supplement in essential hypertension. Blood Press. 1995, 4: 32-41. 10.3109/08037059509077565.CrossRefPubMed
23.
go back to reference Gilleran G, O'Leary M, Bartlett WA, Vinall H, Jones AF, Dodson PM: Effects of dietary sodium substitution with potassium and magnesium in hypertensive type II diabetics: a randomised blind controlled parallel study. J Hum Hypertens. 1996, 10: 517-21.PubMed Gilleran G, O'Leary M, Bartlett WA, Vinall H, Jones AF, Dodson PM: Effects of dietary sodium substitution with potassium and magnesium in hypertensive type II diabetics: a randomised blind controlled parallel study. J Hum Hypertens. 1996, 10: 517-21.PubMed
24.
go back to reference Kawasaki T, Itoh K, Kawasaki M: Reduction in blood pressure with a sodium-reduced, potassium- and magnesium-enriched mineral salt in subjects with mild essential hypertension. Hypertens Res. 1998, 21: 235-43. 10.1291/hypres.21.235.CrossRefPubMed Kawasaki T, Itoh K, Kawasaki M: Reduction in blood pressure with a sodium-reduced, potassium- and magnesium-enriched mineral salt in subjects with mild essential hypertension. Hypertens Res. 1998, 21: 235-43. 10.1291/hypres.21.235.CrossRefPubMed
25.
go back to reference Katz A, Rosenthal T, Maoz C, Peleg E, Zeidenstein R, Levi Y: Effect of a mineral salt diet on 24-h blood pressure monitoring in elderly hypertensive patients. J Hum Hypertens. 1999, 13: 777-80. 10.1038/sj.jhh.1000837.CrossRefPubMed Katz A, Rosenthal T, Maoz C, Peleg E, Zeidenstein R, Levi Y: Effect of a mineral salt diet on 24-h blood pressure monitoring in elderly hypertensive patients. J Hum Hypertens. 1999, 13: 777-80. 10.1038/sj.jhh.1000837.CrossRefPubMed
26.
go back to reference China Salt Substitute Study Collaborative Group: Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial. J Hypertens. 2007, 25: 2011-8.CrossRef China Salt Substitute Study Collaborative Group: Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial. J Hypertens. 2007, 25: 2011-8.CrossRef
27.
go back to reference Hooper L, Bartlett C, Davey Smith G, Ebrahim S: Systematic review of long term effects of advice to reduce dietary salt in adults. BMJ. 2002, 325: 628-10.1136/bmj.325.7365.628.CrossRefPubMedPubMedCentral Hooper L, Bartlett C, Davey Smith G, Ebrahim S: Systematic review of long term effects of advice to reduce dietary salt in adults. BMJ. 2002, 325: 628-10.1136/bmj.325.7365.628.CrossRefPubMedPubMedCentral
28.
go back to reference Klaus D, Hoyer J, Middeke M: Salt restriction for the prevention of cardiovascular disease. Dtsch Arztebl Int. 2010, 107: 457-462.PubMedPubMedCentral Klaus D, Hoyer J, Middeke M: Salt restriction for the prevention of cardiovascular disease. Dtsch Arztebl Int. 2010, 107: 457-462.PubMedPubMedCentral
29.
go back to reference Kastarinen M, Laatikainen T, Salomaa V, Jousilahti P, Antikainen R, Tuomilehto J, et al: Trends in lifestyle factors affecting blood pressure in hypertensive and normotensive Finns during 1982-2002. J Hypertens. 2007, 25: 299-305. 10.1097/HJH.0b013e328010ca88.CrossRefPubMed Kastarinen M, Laatikainen T, Salomaa V, Jousilahti P, Antikainen R, Tuomilehto J, et al: Trends in lifestyle factors affecting blood pressure in hypertensive and normotensive Finns during 1982-2002. J Hypertens. 2007, 25: 299-305. 10.1097/HJH.0b013e328010ca88.CrossRefPubMed
30.
go back to reference Laatikainen T, Pietinen P, Valsta L, Sundvall J, Reinivuo H, Tuomilehto J: Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006, 60: 965-70. 10.1038/sj.ejcn.1602406.CrossRefPubMed Laatikainen T, Pietinen P, Valsta L, Sundvall J, Reinivuo H, Tuomilehto J: Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006, 60: 965-70. 10.1038/sj.ejcn.1602406.CrossRefPubMed
31.
go back to reference Cappuccio FP, MacGregor GA: Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991, 9: 465-473. 10.1097/00004872-199105000-00011.CrossRefPubMed Cappuccio FP, MacGregor GA: Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991, 9: 465-473. 10.1097/00004872-199105000-00011.CrossRefPubMed
32.
go back to reference Khaw KT, Barrett-Connor E: The association between blood pressure, age and dietary sodium and potassium: a population study. Circulation. 1988, 77: 53-61. 10.1161/01.CIR.77.1.53.CrossRefPubMed Khaw KT, Barrett-Connor E: The association between blood pressure, age and dietary sodium and potassium: a population study. Circulation. 1988, 77: 53-61. 10.1161/01.CIR.77.1.53.CrossRefPubMed
33.
go back to reference Wirell MP, Wester PO, Stegmayr BG: Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. J Intern Med. 1994, 236: 189-95. 10.1111/j.1365-2796.1994.tb01282.x.CrossRefPubMed Wirell MP, Wester PO, Stegmayr BG: Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. J Intern Med. 1994, 236: 189-95. 10.1111/j.1365-2796.1994.tb01282.x.CrossRefPubMed
34.
go back to reference Witteman JCM, Grobbee DE, Derkx FHM, Bouillon R, de Bruijn AM, Hofman A: Reduction of blood pressure with oral magnesium supplementation in women with mild and moderate hypertension. Am J Clin Nutr. 1994, 60: 129-135.PubMed Witteman JCM, Grobbee DE, Derkx FHM, Bouillon R, de Bruijn AM, Hofman A: Reduction of blood pressure with oral magnesium supplementation in women with mild and moderate hypertension. Am J Clin Nutr. 1994, 60: 129-135.PubMed
35.
go back to reference Sanjuliani AF, de Abreu Fagundes VG, Francischetti EA: Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients. Int J Cardiol. 1996, 56: 117-83.CrossRef Sanjuliani AF, de Abreu Fagundes VG, Francischetti EA: Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients. Int J Cardiol. 1996, 56: 117-83.CrossRef
36.
go back to reference Itoh K, Kawasaka T, Nakamura M: The effects of high oral magnesium supplementation on blood pressure, serum lipids and related variables in apparently healthy Japanese subjects. Br J Nutr. 1997, 78: 737-50. 10.1079/BJN19970191.CrossRefPubMed Itoh K, Kawasaka T, Nakamura M: The effects of high oral magnesium supplementation on blood pressure, serum lipids and related variables in apparently healthy Japanese subjects. Br J Nutr. 1997, 78: 737-50. 10.1079/BJN19970191.CrossRefPubMed
37.
go back to reference Kawano Y, Matsuoka H, Takishita S, Omae T: Effects of magnesium supplementation in hypertensive patients: assessment by office, home and ambulatory blood pressure. Hypertension. 1998, 32: 260-5.CrossRefPubMed Kawano Y, Matsuoka H, Takishita S, Omae T: Effects of magnesium supplementation in hypertensive patients: assessment by office, home and ambulatory blood pressure. Hypertension. 1998, 32: 260-5.CrossRefPubMed
38.
go back to reference Grobbee DE: Methodology of sodium sensitivity assessment. Hypertension. 1991, 17: 109-114.CrossRef Grobbee DE: Methodology of sodium sensitivity assessment. Hypertension. 1991, 17: 109-114.CrossRef
Metadata
Title
Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure
Authors
Essi S Sarkkinen
Mika J Kastarinen
Tarja H Niskanen
Pia H Karjalainen
Taisa M Venäläinen
Jay K Udani
Leo K Niskanen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Nutrition Journal / Issue 1/2011
Electronic ISSN: 1475-2891
DOI
https://doi.org/10.1186/1475-2891-10-88

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