Korean J Fam Pract. 2018; 8(3): 359-363  https://doi.org/10.21215/kjfp.2018.8.3.359
Association between Blood Presure and Urinary Sodium in Korean Adults
Won-Chul Yang*, Byung-Du Kang, Sang-Eun Yu, Joung-Hwan Kim, Jae-Yeol Ryu
Department of Family Medicine, Serim Hospital, Incheon, Korea
Won-Chul Yang
Tel: +82-2-536-0740, Fax: +82-2-536-0740
E-mail: ethernhunt@hanmail.net
ORCID: http://orcid.org/0000-0001-5759-985X
Received: May 11, 2017; Accepted: July 26, 2017; Published online: June 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Hypertension, one of the most prevalent diseases in Korean adults, can cause stroke and other cardiovascular diseases that could be fatal. Although sodium is recognized as a risk factor for hypertension, the current salt intake among Koreans is relatively high. We examined the relationship between blood pressure and urinary sodium levels in the general Korean population.
Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey between 2014 and 2015 and included 5,898 participants in our study. Patients were divided into 5 groups based on SBP and DBP readings: ≥150 mmHg, 140–149 mmHg, 130–139 mmHg, 120–129 mmHg, and <120 mmHg. We evaluated the participants based on sex; age; body mass index; and glycosylated hemoglobin, total cholesterol, low-density lipoprotein, and triglyceride levels. Multiple logistic regression models were used to assess the association between urinary sodium and blood pressure. We calculated the odds ratios (ORs) for the urinary sodium-to-creatinine ratio.
Results: Urinary sodium-to-creatinine ratios showed a correlation with SBP (r=0.228, P<0.0001) and DBP (r=0.075, P<0.0001). ORs (95% confidence intervals [CI]) for the urinary sodium-to-creatinine ratio after adjustment were 1.00, 1.207 (95% CI, 0.991–1.469), 1.277 (95% CI, 1.00–1.632), 1.399 (95% CI, 1.015–1.927), and 2.89 (95% CI, 1.933–4.323) for the five SBP (DBP) groups and 1.00, 1.05 (95% CI, 0.669–1.646), 1.132 (95% CI, 0.72–1.78), 1.415 (95% CI, 0.89–2.25), and 1.407 (95% CI, 0.829–2.39) for the five SBP (DBP) groups, respectively.
Conclusion: Higher SBP was independently associated with a higher urinary sodium-to-creatinine ratio, which indicates an individual’s dietary sodium intake.
Keywords: Sodium; Hypertension; Diet
  1. Messerli FH, Schmieder RE, Weir MR. Salt. A perpetrator of hypertensive target organ disease? Arch Intern Med 1997; 157: 2449-52.
  2. He FJ, MacGregor GA. Salt, blood pressure and cardiovascular disease. Curr Opin Cardiol 2007; 22: 298-305.
    Pubmed CrossRef
  3. Campbell NR, Burgess E, Choi BC, Taylor G, Wilson E, Cléroux J, et al. Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ 1999; 160(9 Suppl): S1-6.
    Pubmed KoreaMed
  4. Khan NA, Hemmelgarn B, Herman RJ, Bell CM, Mahon JL, Leiter LA, et al. The 2009 Canadian hypertension education program recommendations for the management of hypertension: part 2--therapy. Can J Cardiol 2009;25: 287-98.
  5. Blaustein MP, Hamlyn JM. Signaling mechanisms that link salt retention to hypertension: endogenous ouabain, the Na+ pump, the Na+/Ca2+ exchanger and TRPC proteins. Biochim Biophys Acta 2010; 1802: 1219-29.
    Pubmed KoreaMed CrossRef
  6. Park SM, Jee J, Joung JY, Cho YY, Sohn SY, Jin SM, et al. High dietary sodium intake assessed by 24-hour urine specimen increase urinary calcium excretion and bone resorption marker. J Bone Metab 2014; 21: 189-94.
    Pubmed KoreaMed CrossRef
  7. Pfister R, Michels G, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study. Eur J Heart Fail 2014; 16: 394-402.
    Pubmed CrossRef
  8. Gardener H, Rundek T, Wright CB, Elkind MS, Sacco RL. Dietary sodium and risk of stroke in the Northern Manhattan study. Stroke 2012 ;43: 1200-5.
    Pubmed KoreaMed CrossRef
  9. Dias-Neto M, Pintalhao M, Ferreira M, Lunet N. Salt intake and risk of gastric intestinal metaplasia: systematic review and meta-analysis. Nutr Cancer 2010; 62: 133-47.
    Pubmed CrossRef
  10. Liu N, Sun W, Xing Z, Ma F, Sun T, Wu H, et al. Association between sodium intakes with the risk of chronic kidney disease: evidence from a meta-analysis. Int J Clin Exp Med 2015; 8: 20939-45. eCollection 2015.
  11. Blaustein MP, Zhang J, Chen L, Hamilton BP. How does salt retention raise blood pressure? Am J Physiol Regul Integr Comp Physiol 2006; 290: R514-23.
    Pubmed CrossRef
  12. Freis ED. Salt, volume and the prevention of hypertension. Circulation. 1976; 53: 589-95.
    Pubmed CrossRef
  13. Blaustein MP. Sodium ions, calcium ions, blood pressure regulation, and hypertension:a reassessment and a hypothesis. Am J Physiol 1977; 232: C165-73.
    Pubmed CrossRef
  14. Blaustein MP. The role of Na-Ca exchange in the regulation of tone in vascular smooth muscle. In: Casteels R, Godfraind T, Rüegg JC, editors. International Symposium on Excitation-Contraction Coupling in Smooth Muscle (1977: Louvain, Belgium). Excitation-contraction coupling in smooth muscle : proceedings of the International Symposium on Excitation-Contraction Coupling in Smooth Muscle held in Louvain, Belgium, 12-14 July, 1977 and the Erwin-Riesch Symposium in Heidelberg, Germany, 15-16 July 1977 Amsterdam; New York: Elsevier/North-Holland, 1977. Amsterdam;New York: Elsevier/North-Holland; 1977. p. 101-8.
  15. Khaw KT, Bingham S, Welch A, Luben R, O’Brien E, Wareham N, et al. Blood pressure and urinary sodium in men and women: the norfolk cohort of the European prospective investigation into cancer (EPIC-Norfolk). Am J Clin Nutr 2004; 80: 1397-403.
    Pubmed CrossRef
  16. Umesawa M, Yamagishi K, Noda H, Ikeda A, Sawachi S, Muraki I, et al. The relationship between sodium concentrations in spot urine and blood pressure increases: a prospective study of Japanese general population: the circulatory risk in communities study (CIRCS). BMC Cardiovasc Disord 2016;16: 55.
    Pubmed KoreaMed CrossRef
  17. Fotherby MD, Potter JF. Effects of moderate sodium restriction on clinic and twenty-four-hour ambulatory blood pressure in elderly hypertensive subjects. J Hypertens 1993; 11: 657-63.
  18. Kobayashi Y, Kajiwara N. Treatment of borderline hypertension--moderate salt restriction in the treatment of borderline hypertension. Jpn Circ J 1983;47: 268-75.
    Pubmed CrossRef
  19. Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev 2011; (11):CD004022.
  20. Kalogeropoulos AP, Georgiopoulou VV, Murphy RA, Newman AB, Bauer DC, Harris TB, et al. Dietary sodium content, mortality, and risk for cardiovascular events in older adults: the health, aging, and body composition (Health ABC) study. JAMA Intern Med 2015; 175: 410-9.
    Pubmed KoreaMed CrossRef
  21. Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2011; (7): CD009217.

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