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What is the feasibility of implementing effective sodium reduction strategies to treat hypertension in primary care settings? A systematic review

Ruzicka, Marcela,b; Hiremath, Swapnila; Steiner, Sabinec; Helis, Eftyhiad; Szczotka, Agnieszkae; Baker, Peneloped; Fodor, Georged

doi: 10.1097/HJH.0000000000000182

Objective: To evaluate whether efficacious counseling methods on sodium restriction can be successfully incorporated into primary care models for the management of hypertension.

Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment to identify randomized controlled trials of dietary counseling for salt intake reduction that reported significant reduction in 24-h urinary sodium and blood pressure levels among adults with untreated hypertension. Data extraction and assessment of reproducibility and feasibility were done in duplicate and any disagreements were resolved by consensus.

Results: Six trials were included for assessment of methods as they were efficacious in reducing sodium intake (24-h urinary sodium excretion) by 73 to 93 mmol/day (intervention) vs. 3.2 to 12.5 mmol/day (control). This was paralleled with a reduction in blood pressure (−4 to −27 mmHg) between groups. In four of the six trials, the methods were described in sufficient detail to be reproducible, but in none of these trials were the ‘counseling methods’ feasible for application in primary care settings. Apart from multiple sessions of counseling, the reported interventions were supplemented with provision of prepared food, community cooking classes, and intensive inpatient training sessions.

Conclusion: Despite the availability of efficacious counseling methods for the reduction of sodium intake among newly diagnosed hypertensive patients (feasible within a clinical trial setting), none of these methods, in their present form, are suitable for incorporation into existing primary care settings in countries such as Canada, United States, and UK.

aDivision of Nephrology, The Ottawa Hospital

bDivision of Cardiology, University of Ottawa Heart Institute

cDivision of Angiology/Vascular Medicine, Department of Internal Medicine II, Medical University Vienna

dDivision of Prevention and Rehabilitation

eBerkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Correspondence to Dr George Fodor, Head of Research, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Tel: +1 613 761 4785; fax: +1 613 761 5238; e-mail:

Abbreviations: BP, blood pressure; CHEP, Canadian Hypertension Education Program; DASH, Dietary Approaches to Stop Hypertension; JNC, Joint National Committee; NICE, National Institute for Health and Care Excellence

Received 26 November, 2013

Revised 5 February, 2014

Accepted 18 February, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins