Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Shihezi University School of Medicine, Shihezi, China.
Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
J Am Coll Cardiol. 2024 Feb 20;83(7):711-722. doi: 10.1016/j.jacc.2023.12.013.
Reports on the effects of salt substitution among individuals with normal blood pressure are scarce and controversial.
This study sought to assess the effects of a salt substitute (62.5% NaCl, 25% KCl, and 12.5% flavorings) on incidence of hypertension and hypotension among older adults with normal blood pressure.
A post hoc analysis was conducted among older adults with normal blood pressure participating in DECIDE-Salt, a large, multicenter, cluster-randomized trial in 48 elderly care facilities for 2 years. We used the frailty survival model to compare risk of incident hypertension and the generalized linear mixed model to compare risk of hypotension episodes.
Compared with usual salt group (n = 298), the salt substitute group (n = 313) had a lower hypertension incidence (11.7 vs 24.3 per 100 person-years; adjusted HR: 0.60; 95% CI: 0.39 to 0.92; P = 0.02) but did not increase incidence of hypotension episodes (9.0 vs 9.7 per 100 person-years; P = 0.76). Mean systolic/diastolic blood pressure did not increase from the baseline to the end of intervention in the salt substitute group (mean changes: -0.3 ± 11.9/0.2 ± 7.1 mm Hg) but increased in the usual salt group (7.0 ± 14.3/2.1 ± 7.5 mm Hg), resulting in a net reduction of -8.0 mm Hg (95% CI: -12.4 to -3.7 mm Hg) in systolic and -2.0 mm Hg (95% CI: -4.1 to 0.1 mm Hg) in diastolic blood pressure between intervention groups.
In Chinese older adults with normal blood pressure, replacing usual salt with a salt substitute may reduce the incidence of hypertension without increasing hypotension episodes. This suggests a desirable strategy for population-wide prevention and control of hypertension and cardiovascular disease, deserving further consideration in future studies. (Diet Exercise and Cardiovascular Health [DECIDE]-Salt Reduction Strategies for the Elderly in Nursing Homes in China [DECIDE-Salt]; NCT03290716).
关于正常血压个体中盐替代的效果的报告很少且存在争议。
本研究旨在评估盐替代物（62.5%NaCl、25%KCl 和 12.5%调味料）对正常血压的老年人中高血压和低血压发生率的影响。
在 DECIDE-Salt 大型多中心、集群随机试验中对正常血压的老年人进行了事后分析，该试验在 48 家老年护理机构进行了 2 年。我们使用脆弱性生存模型比较了高血压发生率的风险，使用广义线性混合模型比较了低血压发作的风险。
与普通盐组（n=298）相比，盐替代组（n=313）的高血压发病率较低（每 100 人年 11.7 例 vs 24.3 例；调整 HR：0.60；95%CI：0.39 至 0.92；P=0.02），但低血压发作的发生率没有增加（每 100 人年 9.0 例 vs 9.7 例；P=0.76）。盐替代组的平均收缩压/舒张压从基线到干预结束时没有增加（平均变化：-0.3±11.9/0.2±7.1mmHg），而普通盐组则增加（7.0±14.3/2.1±7.5mmHg），导致收缩压降低 8.0mmHg（95%CI：-12.4 至-3.7mmHg），舒张压降低 2.0mmHg（95%CI：-4.1 至 0.1mmHg）。
在中国正常血压的老年人中，用盐替代物代替普通盐可能会降低高血压的发病率，而不会增加低血压发作的次数。这表明对于高血压和心血管疾病的人群防治，这是一种理想的策略，值得在未来的研究中进一步考虑。（饮食运动与心血管健康[DECIDE]-盐在中国养老院老年人中的减少策略[DECIDE-Salt]；NCT03290716）。
