The Effect Of Long-term Application Of Substitute Salt In Community Patients With Essential Hypertension

Background: Hypertension is a major risk factor for the development and progression of cardiovascular and cerebrovascular diseases.In recent years,enormous amount of epidemiological evidences supported that the prevalence rate of hypertension assumes year by year in China,which attributed to a variety of factors,such as the aging population,unhealthy eating habits and the decline in physical activity.High sodium and low potassium intake in dietary coursed the occurrence and progression of hypertension.It can also induce inflammatory response and aggravate oxidative stress,accelerating the progress of left ventricular hypertrophy,arteriosclerosis and proteinuria,which aggravates the damage to the target-organs.Although,anti-hypertensive treatment by salt restriction is the top priority to prevent cardiovascular diseases,the control rate of hypertension was still blew standard in China.Effective behavioral interventions have been shown that reduce salt intake can lower blood pressure levels.Low-sodium potassium supplement(i.e.substitute salt)was regarded as an effective measure which contributed to salt restriction due to low cost and easy access.However,substitute salt has not been widely used to replace common salt in daily life,and its feasibility and safety need further research.Objective: To observe the effect of replacing regular salt with substitute salt on blood pressure.To assess the effect of substitute salt on plasma inflammatory factors and renin-angiotensin-aldosterone system of patients with hypertension in the community and the safety of substitute salt.Methods: 240 volunteers who met the inclusion criteria continuously enrolled in the experiment in northern China.They were randomly divided into experimental group 5and control group according to 1:1 ratio.The experimental group was given a substitute salt which composition of 43% NACL,32% KCL and 25% excipients.The control group was given normal salt(100% NACL).The experimental intervention lasted for one year,gathered their blood and urine specimens at baseline and one year later,monitoring their clinic blood pressure.At the end of the observation period,229 people who had been using the experimental salt with complete clinical data.Blood pressure,24-hour dynamic blood pressure,plasma hs-CRP,renin,angiotensin II and aldosterone levels were compared between groups after intervention.All the date was analyzed by SPSS 23,P<0.05 was considered statistically significant.Results:1.Compared to baseline,12 months after the substitute salt intervention,the experimental group’s office SBP decreased from(136.78±18.45)mm Hg to(130.71±14.92)mm Hg,DBP decreased from(78.24±10.71)mm Hg to(75.11±10.44)mm Hg,Δ=(6.06±17.79/3.13±9.12)mm Hg(P<0.05).The control group’s SBP decreased from(135.94±17.01)mm Hg to(135.32±14.29)mm Hg,DBP decreased from(77.41±11.57)mm Hg to(77.61±9.99)mm Hg,Δ=(0.63±16.98/-0.31±10.62)mm Hg.The office blood pressure of the experimental group was significantly lower than the control group,about(130.71±14.92 vs135.32±14.29)mm Hg(P<0.05).2.Compared to baseline,12 months after the substitute salt intervention,the 24 h SBP,24 h DBP and DDBP of the experimental group were decreased by(3.14±10.93,1.72±6.52,0.91±11.01)mm Hg(P=0.011,0.005,0.039).The 24 h MAP,DSBP,DMAP,NSBP,NDBP and NMAP showed a downward trend,decreased about(0.66±8.01,1.75±16.06,0.33±8.83,2.40±13.61,0.58±8.18,0.67±10.25)mm Hg(P>0.05).There was no significant difference in the 24-hour blood pressure in the control group after intervention.There was no significant difference in 24-hour blood pressure between experimental group and control group.3.Compared to baseline,12 months after the substitute salt intervention,the experimental group’s hs-CRP levels decreased by(0.32 ± 1.30)mg/ l(P=0.002).There was no significant difference in the control group(P=0.159).The hs-CRP in the experimental group was significantly lower than control group(P=0.025).4.Compared to baseline,12 months after the substitute salt intervention,Plasma renin,aldosterone and angiotensin II levels were increased in the experimental group,about(2.68 ± 11.09)pg/dl,(9.34 ± 48.19)UIU /ml,and(4.70 ± 17.38)pg/ml(P=0.003,0.024,0.011).The control group has no significant difference from baseline.There was no significant difference between two groups.5.No renal adverse events or hyperkalemia were observed related to the use of substitute salts during the experiment.6.A total of 113 people in the substitute salt group insisted on the use of substitute salt,5 people withdrew from the experiment because of the taste problems(bitterness,astringency),and 2 people lost follow-up.It provides that the use of substitute salt was highly complied and the taste can be accepted by patients.Conclusion:After 12 months of intervention with substitute salt,the office blood pressure and 24-hour blood pressure can be reduced,the plasma hs-CRP level of patients with hypertension can also be reduced,and it may be bring additionally beneficial for patients with hypertension.