Die Beschränkung der Kochsalzaufnahme in der Gesamtbevölkerung verspricht langfristig großen Nutzen

Zusammenfassung

Eine Beschränkung der Kochsalzaufnahme führt nicht nur zur Senkung des Blutdrucks und der Hypertonie-Inzidenz, sondern auch zu einer Reduktion der kardiovaskulären Morbidität und Mortalität. Eine hohe Kochsalzaufnahme stellt daher nicht nur einen Risikofaktor für die Hypertonie, sondern für alle kardiovaskulären Erkrankungen dar. Eine moderate Verminderung der täglichen Kochsalzaufnahme in der Gesamtbevölkerung von derzeit 8 – 10 g auf 5 – 6 g ist mit großem Nutzen für Krankheitslast und Ökonomie verbunden. Mögliche Risiken für wenige Personengruppen sind voraussehbar und beherrschbar. Die generelle Kochsalzreduktion ist weder durch individuelle Beratung, Schulungen oder Informationskampagnen allein, sondern nur durch eine Reduktion des Kochsalzgehaltes industriell verarbeiteter Lebensmittel, in Fastfood-Ketten, Restaurants und Kantinen erreichbar, da mit diesen 80 % des täglich aufgenommenen Kochsalzes zugeführt werden. Zur Erreichung des Ziels einer Beschränkung der Kochsalzaufnahme in der Gesamtbevölkerung wird die Gründung einer interdisziplinären und interprofessionellen Task Force „Weniger Salz für alle” vorgeschlagen. In ihr soll die Kompetenz der wissenschaftlichen Gesellschaften und Institutionen gebündelt werden, die in der Reduktion der kardiovaskulären Mortalität und Morbidität durch Primärprävention eine ihrer zentralen Aufgaben sehen. Die Erfolge einer individuellen Prävention bei Risikopatienten werden durch Maßnahmen einer bevölkerungsbezogenen Prävention ganz erheblich verbessert werden, zu denen neben einer generellen Beschränkung der Kochsalzaufnahme nach wie vor die Änderung des Lebensstils gehört.

Summary

Restricting salt intake not only leads to a decrease of blood pressure and a reduction in the incidence of arterial hypertension but also to a fall in cardiovascular morbidity and mortality. But high sodium intake is not only a risk factor for hypertension but also for cardiovascular diseases. Moderate reduction of daily salt intake in the entire population of Germany from the present level of 8–10 mg to 5–6 mg is of great benefit for disease load and to the economy. Any possible risk for a few groups of persons is predictable and can be coped with. General sodium reduction cannot be achieved only by individual advice, instruction or information campaigns but requires a reduction in the sodium content of industrially processed foods, in fast-food chains, restaurants and canteens because they supply 80% of total daily sodium intake. To achieve the target of restricting the sodium intake of the whole population it is recommended that an interdisciplinary and interprofessional task force, „Less salt for all” be established. This is to bring together the expertise of scientific societies and institutions that see their main task in the reduction of cardiovascular mortality and morbidity by primary prevention. Individual prevention in patients at risk can be very significantly improved by population-related preventive measures. These include, in addition to general limitation of sodium intake , continuing change in lifestyle.

Schlüsselwörter

Salzreduktion - Kochsalzzufuhr - arterielle Hypertonie

Keywords

salt reduction - dietary sodium - arterial hypertension

Literatur

• 1 Adrogué H J, Madias N E. Sodium and potassium in the pathogenesis of hypertension.  New Engl J Med. 2007;  356 1966-1978
• 2 Alderman M H, Cohen H, Madhavan S. Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey (NHANES I).  Lancet. 1988;  351 781-785
• 3 Alderman M H, Madhavan S, Cohen H. et al . Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men.  Hypertension. 1995;  25 1144-1152
• 4 Appel L J. At the tipping point: accomplishing population wide sodium-reduction in the United States.  J Clin Hypertens. 2008;  10 7-11
• 5 Appel L J, Moore T J, Obarzanek E, Vollmer W M, Svetkey L P. et al . A clinical trial of the effects of dietary patterns on blood pressure: DASH Collaborative Research Group.  N Engl J Med. 1997;  336 1117-1124
• 6 Appel L J, Brands M W, Daniels S R, Karanja N, Elmer P K, Sacks F M. Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association.  Hypertension. 2006;  47 296-308
• 7 Beevers D G, Lip G YH, Blann A D. Salt intake and Helicobacter pylori infection.  J Hypertens. 2004;  22 1475-1477
• 8 Cappuccio F P, Kalaitzidis R, Ducelift S, Eastwood J B. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism.  J Nephrol. 2000;  13 169-177
• 9 Cappuccio F P, Makandu N D, MacGregor G A. Dietary Salt Intake and Hypertension.  Klin Wochenschr. 1991;  69 (Suppl XXV) 17-25
• 10 Cailar G, Mimram A. Non-pressure related effects of dietary sodium.  Curr Hypertens Rep. 2007;  9 154-159
• 11 Cailar G, Mimran A, Fesler P. et al . Dietary sodium and pulse pressure in normotensive and essential hypertensive subjects.  J Hypertens. 2004;  22 697-703
• 12 Cailar G, Ribstein J, Mimran A. Dietary sodium and target organ damage in essential hypertension.  Am J Hypertens. 2002;  15 222-229
• 13 Carvalho J J, Baruzzi R G, Howard P F. et al . Blood pressure in four remote population in the Intersalt study.  Hypertension. 1989;  14 238-246
• 14 Chang H Y, Hu Y W, Yue C S, Wen Y W, Yeh W T. et al . Effect of potassium-enriched salt on cardiovascular mortality and medial expenses of elderly men.  Am J Clin Nutr. 2006;  83 1289-1296
• 15 Chobanian A V, Bakris G L, Black H R, Cushman W C, Green L A. et al . Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Hypertension. 2003;  43 1206
• 16 Cohen H W, Hailpern S M, Fang J, Alderman M H. Sodium intake and mortality in the NHANES II follow-up study.  Am J Med. 2006;  119 275.e7-14
• 17 Cohen H W, Alderman M H. Sodium, blood pressure, and cardiovascular disease.  Curr Opin Cardiol. 2007;  22 306-310
• 18 Cohen H W, Hailpern S M, Alderman M H. Sodium intake and mortality follow-up in the third national health and nutrition examination survey (NHANES III).  J Gen Intern Med. 2008;  23 297-302
• 19 Conlin P R, Chow D, Miller 3rd E R, Svetky L P. et al . The effect of dietary patterns on blood pressure control in hypertensive patients: results from the dietary approach to stop hypertension (DASH) trial.  Am J Hypertens. 2000;  13 949-955
• 20 Contreras R J, Wong D L, Henderson R. et al . High dietary NaCl development enhances mean arterial pressure of adult rats.  Physiol Behav. 2000;  71 173-181
• 21 Cook N R, Cutler J A, Obarzanek E, Buring J E. et al . Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP).  BMJ. 2007;  334 885-892
• 22 Creager M A, Roddy M, Holland K M. et al . Sodium depresses arterial baroreceptor reflex function in normotensive humans.  Hypertension. 1991;  17 989-996
• 23 Cutler J A, Sorlie P D, Wolz M. et al . Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988 – 1994 and 1999 – 2004.  Hypertension. 2008;  52 818-827
• 24 Dickinson B D, Havas S. Council on Science and Public Health, American Medical Association. Reducing the population burden of cardiovascular disease by reducing sodium intake: a report of the Council on Science and Public Health.  Arch Intern Med. 2007;  167 1460-1468
• 25 Egan B M. Reproducibility of BP responses to changes in dietary salt.  Hypertension. 2003;  42 457
• 26 Ezzati M, Lopez A D, Rodgers A. et al . Selected major risk factors and global and regional burden of disease.  Lancet. 2002;  360 1347-1360
• 27 Foersch C h, Misselwitz B, Sitzer M, Steinmetz H, Neumann-Haefelin T. für die Arbeitsgruppe Schlaganfall Hessen (ASH) . Die Schlaganfallzahlen bis zum Jahr 2050.  Deutsches Ärzteblatt. 2008;  105 467-473
• 28 Food labelling. Health claims and label statements: sodium/hypertension.  Federal Register. 1991;  56 60825-60855
• 29 Franco V, Oparil S. Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival.  J Am Coll Nutr. 2006;  25 (3Suppl) 247S-255S
• 30 Fung T T, Chiuve S E, McCullough M L. et al . Adhaerence to a DASH-style diet and risk of coronary heart disease and stroke in women.  Arch Intern Med. 2008;  168 713-720
• 31 Geleinjnse J M, Hofman A, Witteman J C. et al . Long-term effects of neonatal sodium restriction on blood pressure.  Hypertension. 1997;  29 913-917
• 32 Geleinjnse J M, Grobbee D E. High salt intake early in life: does it increase the risk of hypertension?.  Hypertension. 2002;  20 2121-2124
• 33 Geleijnse J M, Witteman J C, Bak A A, den B reeijen JH, Grobbee D E. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension.  BMJ. 1994;  309 436-440
• 34 Geleijnse J M, Witteman J C, Stijnen T, Kloos M W, Hofman A, Grobbee D E. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study.  Eur J Epidemiol. 2007;  22 763-770
• 35 Girndt J. Hypertonie in der Schwangerschaft. In Klaus D, Hrsg Manuale hypertonologicum. Deisenhofen; Dustri-Verlag 1997
• 36 Grandal N A, Galloe A N, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis.  JAMA. 1998;  279 1383-1391
• 37 Grassi G, Dell’Oro R, Seravalle, Foglia G, Trevano F Q, Mancia G. Short- and long-term neuroadrenergic effects of moderate dietary sodium restriction in essential hypertension.  Circulation. 2002;  106 1957-19611
• 38 Grollman A, Grollman E F. The teratogenic induction of hypertension.  J Clin Invest. 1962;  41 710-714
• 39 Guidelines Committee . 2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension.  J Hypertens. 2003;  21 1011-1053
• 40 Havas S, Roccella E J, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium.  Am J Public Health. 2004;  94 19-22
• 41 He F J, MacGregor G A. How far should salt intake be reduced?.  Hypertension. 2003;  42 1093-1099
• 42 He F J, MacGregor G A. Effect of longer-term modest salt reduction on blood pressure.  Cochrane Database Syst Rev. 2004;  (3) , CD004937
• 43 He F J, Markandu N D, MacGregor G A. Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension.  Hypertension. 2005;  46 66-70
• 44 He F J, MacGregor G A. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials.  Hypertension. 2006;  48 861-869
• 45 He F J, Marrero N M, MacGregor G A. Salt and blood pressure in children and adolescents.  J Hum Hypertens. 2008;  22 4-11
• 46 He F J, Marrero N M, MacGregor G A. Salt intake is related to soft drink consumption in children and adolescents: a link to obesity?.  Hypertension. 2008;  51 629-634
• 47 He J, Ogden L G, Vupputuri S, Bazzano L A, Loria C, Whelton P K. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults.  JAMA. 1999;  282 2027-2034
• 48 He J, Ogden L G, Bazzano L A. et al . Dietary sodium intake and incidence of congestive heart failure in overweight US men and women.  Arch Intern Med. 2002;  162 1619-1624
• 49 He J, Whelton P K, Appel L J, Chaleston J, Klag M J. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension.  Hypertension. 2000;  35 544-549
• 50 Higashi Y, Sasaki S, Nakagawa K, Kimura M. et al . Sodium chloride loading does not alter endothelium-dependent vasodilation of forearm vasculature in either salt-sensitive or salt-resistent patients with essential hypertension.  Hypertens Res. 2001;  24 711-716
• 51 Holzgreve H. Erfolge, Indikationen und Ziele der Hochdrucktherapie. In Klaus D, Hrsg Manuale hypertonologicum. Deisenhofen; Dustri-Verlag 1997
• 52 Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Systematic review of long term effects to advice to reduce dietary salt in adults.  BMJ. 2002;  325 628
• 53 Howard B V, Van Horn L, Hsia J, Manson J E, Stefanick M l. et al . Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial.  JAMA. 2006;  295 655-666
• 54 Hypertension Prevention Collaborative Research Group . Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II.  Arch Intern Med. 1997;  157 657-667
• 55 Hypertension Prevention Trial Research Group . The Hypertension Prevention Trial: Three-year effects of dietary changes on blood pressure.  Arch Intern Med. 1990;  150 2408-2409
• 56 Joffres M R, Campbell N R, Mann B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada.  Can J Cardiol. 2007;  23 437-443
• 57 Jones G, Richardson M. An objective examination of consumer perception of nutrition information based on healthiness ratings and eye movements.  Public Health Nutr. 2007;  10 238-244
• 58 Karppanen H, Mervaala E. Sodium intake and hypertension.  Prog Cardiovasc Dis. 2006;  49 59-75
• 59 Kastainen M J, Salomaa V V, Vartainen E A, Jousilahti P J. et al . Trends in blood pressure levels and control of hypertension in Finland from 1982 to 1997.  J Hypertens. 1998;  16 1379-1387
• 60 Kawasaki T, Itoh K, Uezono K, Ogaki T. et al . Investigation of high salt intake in a Nepalese population with low blood pressure.  J Hum Hypertens. 1993;  7 131-140
• 61 Klaus D, Middeke M, Hoyer J. Beschränkung der Kochsalzaufnahme für die Gesamtbevölkerung? Aufruf zur Gründung einer Task Force „Weniger Salz für alle”.  Dtsch Med Wochenschr. 2008;  133 1317-1319
• 62 Knecht S, Wersching H, Lohmann H, Bruchmann M, Duning T, Dziewas R, Berger K, Ringelstein E B. High-normal blood pressure is associated with poor cognitive performance.  Hypertension. 2008;  51 663-668
• 63 Kreutz R, Fernandez-Alfonso M S, Liu Y, Ganten D, Paul M. Induction of angiotensin-I-converting enzyme with dietary NaCl-loading in genetically hypertensive and normotensive rats.  J Mol Med. 1995;  73 243-248
• 64 Kumanyika S K, Cook N R, Cutler J A, Belden L. et al . Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II.  J Hum Hypertens. 2005;  19 33-45
• 65 Law M R, Frost C D, Wald N Y. By how much does dietary salt reduction lower blood pressure.  BMJ. 1991;  302 811-824
• 66 Lichtenstein A, Appel L J, Brands M, Carnethon M. et al . Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.  Circulation. 2006;  114 82-96
• 67 Liebson P R, Grandits G A, Dianzumba S, Prineas R J. et al . Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the treatment of mild hypertension study (TOMHS).  Circulation. 1995;  91 698-706
• 68 de Lorgeril M, Salen P, Matin J L, Monjaud I. et al . Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Heart Study.  Circulation. 1999;  99 779-785
• 69 Maberly G F, Haxton D P, van der Haar F. Iodine deficiency: consequences and progress toward elimination.  Food Nutr Bull. 2003;  24 (4Suppl) S91-S98
• 70 Mallamaci F, Lonardis D, Billizzi V, Zoccali C. Does high salt intake cause hyperfiltration in patients with essential hypertension?.  J Hum Hypertens. 1996;  10 157-161
• 71 Mellen P, Gao S K, Vitolius S Z, Goff Jr D C. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988 – 1994 and 1999 – 2004.  Arch Intern Med. 2008;  168 308-314
• 72 Messerli F H, Schmieder R E. Salt and Hypertension: Going to the Heart of the Matter.  Arch Intern Med. 2001;  161 505-506
• 73 Nagata C, Takatsuka N, Shimizu N, Shimizu H. Sodium intake and risk of death from stroke in Japanese men and women.  Stroke. 2004;  35 1543-1547
• 74 Neaton J D, Grimm Jr R H, Prineas R J, Stamler J. et al . Treatment of Mild Hypertension Study. Final results.  JAMA. 1993;  270 713-724
• 75 Obarzanek E, Proschan M A, Vollmer W M, Moore T J, Sacks F M, Appel L J. et al . Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial.  Hypertension. 2003;  42 459-467
• 76 Oberleithner H, Riethmüller C, Schillers H, MacGregor G A, de Wardener H E, Hausberg M. Plasma sodium stiffens vascular endothelium and reduces nitric oxidase release.  Proc Nat Acad Sci USA. 2007;  104 16281-16286
• 77 Parikh N I, Gona P, Larson M G, Wang T J, Newton-Cheh C. et al . Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study.  Eur Heart J. 2007;  28 2644-2652
• 78 Penner S B, Campbell N R, Chockalingam A. et al . Dietary sodium and cardiovascular outcomes: a rational approach.  Can J Cardiol. 2007;  23 567-572
• 79 Pietinen P, Vartiainen E, Seppänen R, Aro A, Puska P. Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk.  Prev Med. 1996;  25 243-250
• 80 Lewington S, Clarke R, Collins R. et al, Prospective studies collaboration . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for 1 million adults in 61 prospective studies.  Lancet. 2002;  30 1903-1913
• 81 Rosamund W, Flegal K, Furie K, Go A, Greenlund K. et al . Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.  Circulation. 2008;  117 e25-146
• 82 Rose G, Stamler J. The INTERSALT study: background, methods and main results. INTERSALT Co-operative Research Group.  J Hum Hypertens. 1989;  3 283-288
• 83 Sacks F M, Svetkey L P, Vollmer W M, Appel L J. et al, for the DASH-Sodium Collaborative Research Group . Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet: DASH Sodium Collaborative Research Group.  N Engl J Med. 2001;  344 3-10
• 84 Safar M E, Asmar R G, Benetos A. et al . Sodium, large arteries and diuretic compounds in hypertension.  J Hypertension. 1992;  10 (Suppl) S133-6
• 85 Schmieder R E, Messerli F H, Garavaglia G E, Nunez B D. Dietary salt intake: a determinant of cardiac involvement in essential hypertension.  Circulation. 1988;  78 951-961
• 86 Stamler J, Rose G, Stamler R, Elliott P. et al . INTESALT study findings. Public health and medical care implications.  Hypertension. 1989;  14 570-577
• 87 Stamler R. Implications of the INTERSALT study.  Hypertension. 1991;  17 (Suppl I) I-16-I-20
• 88 Stamler R, Rose G, Elliot P, Dyer A, Marmot M. et al . Findings of the Internaional Cooperative INTERSALT Study.  Hypertension. 1994;  17 (Suppl) 117-120
• 89 Stockley L. Toward public health nutrition strategies in the European Union to implement food based dietary guidelines and to enhance healthier lifestyles.  Public Health Nutr. 2001;  4 307-324
• 90 Swift P A, Markandu N D, Sagnella G A, He F J, MacGregor G A. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial.  Hypertension. 2005;  46 308-312
• 91 Svetkey L P, Simons-Morton D, Vollmer W M, Appel L J, Conlin P R. et al . Effects of dietary patterns on blood pressure: subgroup analysis of the dietary approach to stop hypertension (DASH) trial.  Arch Intern Med. 1999;  159 285-293
• 92 Takeda Y, Yoneda T, Demura M. et al . Sodium-induced cardiac aldosterone synthesis causes cardiac hypertrophy.  Endocrinology. 2000;  141 1901-1904
• 93 The Trials of Hypertension Prevention Collaborative Research Group . The effect of nonpharmacological intervention on blood pressure of persons with high normal levels. Phase I (TOHP I).  JAMA. 1992;  267 1213-1220
• 94 Trichopoulo A, Orfanos P, Norat T, Bueno-de-Mesquita B. et al . Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study.  BMJ. 2005;  330 991-998
• 95 Tunstall-Pedoe H, Woodward M, Travendale R, Brook R A, McCluskey M K. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study: cohort study.  BMJ. 1997;  315 722-729
• 96 Tuomilehto J, Jousilahti P, Rastenvte D, Moltchanov. et al . Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study.  Lancet. 2001;  357 848-851
• 97 Ueshima H, Tatara K, Asakura S, Okamoto M. Declining trends in blood pressure level and the prevalence of hypertension, and changes in related factors in Japan 1956 – 1980.  J Chron Dis. 1987;  40 137-147
• 98 Vital and Health Statistics Division, Statistics and Information Department, Ministry of Health, Labour and Welfare, Japan. 
• 99 World Health Organization .Reducing Salt Intake In Populations. Report of a WHO Forum 2006
• 100 Wolf-Meier K, Cooper R S, Banegas J R, Giampaoli S, Hense H W. et al . Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States.  JAMA. 2003;  289 2420-2422
• 101 Yamori Y, Nara Y, Mizumisha S. et al . Nutritional factors for stroke and major cardiovascular diseases: international epidemiological comparison of dietary prevention.  Health Rep. 1994;  6 22-27
• 102 Yu H CM, Burrell L M, Black M J. et al . Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats.  Circulation. 1998;  98 2621-2628