Junli Tang

Hypertension Prevalence, Awareness, Treatment, and Control and Sodium Intake in Shandong Province, China: Baseline Results From Shandong–Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011

Introduction In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. Methods Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. Results Overall, 23.4% (95% confidence interval [CI], 20.9%–26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg–6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg–4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg–5,683 mg). Conclusion Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China.

Association between 24 h urinary sodium and potassium excretion and the metabolic syndrome in Chinese adults: the Shandong and Ministry of Health Action on Salt and Hypertension (SMASH) study

The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults.

Estimating daily salt intake based on 24 h urinary sodium excretion in adults aged 18-69 years in Shandong, China.

Objective 24 h urinary sodium extretion was used to estimate the daily salt intake of shandong residents aged from 18 to 69 years in China. Setting 20 selected counties/districts in Shandong stratified by geographic region (Eastern, Central Southern and North Western) and residence type (urban vs rural). Participants Among 2184 randomly selected adults, 2061 provided usable 24 h urine samples. Urine volume <500 mL or male creatinine <3.81 (female creatinine <4.57) are not included in the analysis. Results The mean sodium level excreted over 24 h was 237.61 mmol (95% CI 224.77 to 250.44) mmol. Overall, the estimated mean salt intake was 13.90 g/day (95% CI 13.15 to 14.65). The mean salt intake among rural residents was higher than that among urban residents (14.00 vs 13.68 g; p<0.01). Salt intake in men was higher than that in women (14.40 vs 13.37 g; p<0.01). Approximately 96% of the survey participants had a dietary salt intake of ≥6 g/day. Conclusions The salt intake in Shandong is alarmingly higher than the current recommended amount (6 g/day). Thus, effective interventions to reduce salt intake levels to combat the increasing burden of non-communicable diseases need to be developed and implemented.

Relationships Between Blood Pressure and 24-Hour Urinary Excretion of Sodium and Potassium by Body Mass Index Status in Chinese Adults.

This study examined the impact of overweight/obesity on sodium, potassium, and blood pressure associations using the Shandong‐Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project baseline survey data. Twenty‐four–hour urine samples were collected in 1948 Chinese adults aged 18 to 69 years. The observed associations of sodium, potassium, sodium‐potassium ratio, and systolic blood pressure (SBP) were stronger in the overweight/obese population than among those of normal weight. Among overweight/obese respondents, each additional standard deviation (SD) higher of urinary sodium excretion (SD=85 mmol) and potassium excretion (SD=19 mmol) was associated with a 1.31 mm Hg (95% confidence interval, 0.37–2.26) and −1.43 mm Hg (95% confidence interval, −2.23 to −0.63) difference in SBP, and each higher unit in sodium‐potassium ratio was associated with a 0.54 mm Hg (95% confidence interval, 0.34–0.75) increase in SBP. The association between sodium, potassium, sodium‐potassium ratio, and prevalence of hypertension among overweight/obese patients was similar to that of SBP. Our study indicated that the relationships between BP and both urinary sodium and potassium might be modified by BMI status in Chinese adults.

RETRACTED: Urinary sodium or potassium excretion and blood pressure in adults of Shandong province, China: preliminary results of the SMASH project

The aim of the study was to estimate the urinary electrolyte excretion and assess the relationship between dietary sodium or potassium intake and blood pressure within a population of 18-69 adults in Shandong province, China. Random samples of 2184 adults enrolled in the Shandong and Ministry of Health Action on Salt reduction and Hypertension project were collected from 20 countries or districts. Electrolyte intake was estimated by 24-hour urine collections, and urinary volume or creatinine was measured to estimate the accuracy of the collection. Anthropometry was measured with standard procedures. Regression analysis was used to assess the relationship between electrolyte excretion and blood pressure. The mean sodium excretion was 241.8 ± 7.9 mmol among men and 222.3 ± 7.9 mmol among women, respectively. The 24-hour average potassium excretion was 39.9 ± 0.9 and 41.8 ± 1.1 mmol, respectively. Some resident and geographic differences were found for 24-hour urinary electrolyte. Regression analysis showed increments of 1.15 mm Hg in systolic blood pressure and 0.67 mm Hg in diastolic blood pressure per gram increment in urinary sodium excretion. For each increment of 1-g potassium excretion per day, there was a decrement of 0.81 mm Hg in systolic blood pressure and 0.76 mm Hg in diastolic blood pressure. The highest blood pressure was observed in the group with lowest potassium and the highest sodium excretion, which was 13.6 mm Hg in systolic blood pressure and 7.3 mm Hg in diastolic blood pressure difference from group with highest potassium excretion and lowest sodium excretion (P < .0001 for interaction). The Shandong and Ministry of Health Action on Salt reduction and Hypertension project results show a substantially higher sodium excretion and a lower potassium excretion than recommended in Shandong adults. The sodium or potassium intake is positively association with blood pressure. These results support the recommended approaches to lower the risk of hypertension, including lower sodium intake, higher potassium intake, and prevention and control of obesity.

Population-based association between urinary excretion of sodium, potassium and its ratio with albuminuria in Chinese.

BACKGROUND AND OBJECTIVES Albuminuria is a risk factor for cardiovascular and renal disease. However, little is known about the association of 24 h urinary sodium and potassium excretion with albuminuria in China. The aim of this study was to examine this association by analyzing the data from 1,975 Chinese adults living in north China. METHODS AND STUDY DESIGN Excretion of urinary sodium, potassium and albumin was assessed in a single 24-h urine sample for each participant. Height, weight, waist circumference and blood pressure were measured and body mass index was determined as weight divided by square height. Fasting blood sample was collected and fasting glucose was measured. RESULTS The average 24-h urinary sodium and potassium excretion were 232 mmol and 40.8 mmol, resulting a mean sodium to potassium ratio of 6.7. The median (Q1-Q3) 24-h urinary albuminuria excretion was 6.1 mg (4.5-8.7 mg). Overall, urinary sodium excretion was positively associated with albumin excretion (β=0.029, p<0.001). This association was independent of major cardiovascular risk factors including age, gender, systolic blood pressure, body mass index, fasting glucose, waist circumference, hypertensive drug treatment, and smoking. Moreover, the relation of sodium and albumin was similar in the subgroups stratified by gender, adiposity and diabetic status. No significant associations of potassium excretion or sodium to potassium ratio with urinary albumin excretion were observed. CONCLUSIONS In cross-sectional analyses, high sodium intake was shown to be associated with increased urinary albuminuria in the general Chinese adult population, supporting salt restriction for renal and cardiovascular health benefit.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension (SMASH) Project

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion>9 g/d, but reported low or moderate sodium intake. The agreement between self-reported sodium intake level and 24-h urine sodium excretion level was low in both normotensive subjects and hypertensive subjects. These findings suggested that many subjects who reported low sodium intake had actual urine sodium excretion>9 g/d. Sodium intake is often underestimated in both hypertensive and normotensive participants in China.

Are Microalbuminuria and Elevated 24 H Urinary Microalbumin Excretion within Normal Range Associated with Metabolic Syndrome in Chinese Adults

The association of microalbuminuria and elevated 24 h urinary microalbumin excretion (UAE) with metabolic syndrome (MetS) has not been well examined in Chinese Adults. In the present study, a population-based cross-sectional study was conducted among Chinese adults aged 18–69 years in Shandong province in 2011 to determine the relationship between them. Data on 24 h UAE and other variables were obtained and components of MetS were examined. The prevalence of MetS and mean 24 h UAE was 24.7% and 6.7 mg, respectively. Compared with participants with normoalbuminuria, the odds of MetS and its components including central obesity, elevated blood pressure and elevated fasting glucose, but not the odds of low HDL cholesterol and elevated triglycerides, significantly increased in those with microalbuminuria. Additionally, the odds of MetS and its three components significantly increased across increasing quartiles of 24 h UAE within normal range (1.00, 1.11, 1.02 and 1.58, respectively, for MetS; 1.00, 1.14, 1.21, and 1.68, respectively, for central obesity; 1.00, 1.35, 1.26 and 1.68, respectively, for elevated blood pressure; and 1.00, 1.32, 1.06 and 1.47, respectively, for elevated triglycerides; p for linear trend ≤0.05 for all). Furthermore, for each increment of 10 mg 24 h UAE within normal range, the odds of MetS and its components including central obesity, elevated blood pressure, and elevated triglycerides significantly increased by 53%, 65%, 55%, and 41%, respectively. These findings suggest that both microalbuminuria and elevated 24 h UAE within normal range might be important risk factors for MetS in Chinese adults.