盐替代品对临床结局的影响：系统评价和荟萃分析。

Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis.

机构信息

The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.

School of Health Science, The University of Newcastle, Newcastle, New South Wales, Australia.

出版信息

Heart. 2022 Sep 26;108(20):1608-1615. doi: 10.1136/heartjnl-2022-321332.

DOI:10.1136/heartjnl-2022-321332

PMID:35945000

Abstract

OBJECTIVES

The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results.

METHODS

We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups.

RESULTS

There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was -4.61 mm Hg (95% CI -6.07 to -3.14) and of diastolic blood pressure (DBP) was -1.61 mm Hg (95% CI -2.42 to -0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity >0.05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a -1.53 mm Hg (95% CI -3.02 to -0.03, p=0.045) greater reduction in SBP and a -0.95 mm Hg (95% CI -1.78 to -0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94).

CONCLUSIONS

The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide.

TRIAL REGISTRATION NUMBER

CRD42020161077.

摘要

目的

盐替代物与中风研究（SSaSS）最近报告了富含钾的盐替代物对心血管结局和死亡的血压介导益处。本研究评估了盐替代品对广泛结局的影响，以量化研究结果的一致性，并了解 SSaSS 结果的可能普遍性。

方法

我们检索了 PubMed、Embase 和 Cochrane 图书馆截至 2021 年 8 月 31 日的数据。纳入了报告盐替代物对血压或临床结局影响的平行组、阶梯楔形或群组随机对照试验。采用荟萃分析和荟萃回归来确定试验间、地理区域和患者群体间结果的一致性。

结果

共纳入 21 项试验和 31949 名参与者，其中 19 项报告了对血压的影响，5 项报告了对临床结局的影响。收缩压（SBP）总体降低 4.61mmHg（95%CI-6.07 至-3.14），舒张压（DBP）降低 1.61mmHg（95%CI-2.42 至-0.79）。血压降低似乎在地理区域和按年龄、性别、高血压史、体重指数、基线血压、基线 24 小时尿钠和基线 24 小时尿钾定义的人群亚组中具有一致性（所有 p 同质性>0.05）。荟萃回归显示，盐替代物中氯化钠的比例每降低 10%，SBP 降低 1.53mmHg（95%CI-3.02 至-0.03，p=0.045），DBP 降低 0.95mmHg（95%CI-1.78 至-0.12，p=0.025）。盐替代物对全因死亡率（风险比（RR）0.89，95%CI 0.85 至 0.94）、心血管死亡率（RR 0.87，95%CI 0.81 至 0.94）和心血管事件（RR 0.89，95%CI 0.85 至 0.94）具有明确的保护作用。