PURE

PURE^? study

Abstract

BACKGROUND :
Higher levels of sodium intake are reported to be associated with higher blood pressure. Whether this relationship varies according to levels of sodium or potassium intake and in different populations is unknown.

METHODS :
We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device.

RESULTS :
Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion. The slope of this association was steeper with higher sodium intake (an increment of 2.58 mm Hg in systolic blood pressure per gram for sodium excretion >5 g per day, 1.74 mm Hg per gram for 3 to 5 g per day, and 0.74 mm Hg per gram for <3 g per day ; P<0.001 for interaction). The slope of association was steeper for persons with hypertension (2.49 mm Hg per gram) than for those without hypertension (1.30 mm Hg per gram, P<0.001 for interaction) and was steeper with increased age (2.97 mm Hg per gram at >55 years of age, 2.43 mm Hg per gram at 45 to 55 years of age, and 1.96 mm Hg per gram at <45 years of age ; P<0.001 for interaction). Potassium excretion was inversely associated with systolic blood pressure, with a steeper slope of association for persons with hypertension than for those without it (P<0.001) and a steeper slope with increased age (P<0.001).

CONCLUSIONS :
In this study, the association of estimated intake of sodium and potassium, as determined from measurements of excretion of these cations, with blood pressure was nonlinear and was most pronounced in persons consuming high-sodium diets, persons with hypertension, and older persons. (Funded by the Heart and Stroke Foundation of Ontario and others.).

Références :

Association of urinary sodium and potassium excretion with blood pressure.
N Engl J Med. 2014 Aug 14 ;371(7):601-1.

Reference : Mente A, O’Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, Morrison H, Li W, Wang X, Di C, Mony P, Devanath A, Rosengren A, Oguz A, Zatonska K, Yusufali AH, Lopez-Jaramillo P, Avezum A, Ismail N, Lanas F, Puoane T, Diaz R, Kelishadi R, Iqbal R, Yusuf R, Chifamba J, Khatib R, Teo K, Yusuf S ; PURE Investigators. Association of urinary sodium and potassium excretion with blood pressure.N Engl J Med.2014 Aug 14 ;371(7):601-11. doi : 10.1056/NEJMoa1311989.. 25119606

Urinary sodium and potassium excretion, mortality, and cardiovascular events.
N Engl J Med. 2014 Aug 14 ;371(7):612-2. doi : 1.1056/NEJMoa131188.
Reference : O’Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, Yan H, Lee SF, Mony P, Devanath A, Rosengren A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Yusoff K, Iqbal R, Ilow R, Mohammadifard N, Gulec S, Yusufali AH, Kruger L, Yusuf R, Chifamba J, Kabali C, Dagenais G, Lear SA, Teo K, Yusuf S ; PURE Investigators. Urinary sodium and potassium excretion, mortality, and cardiovascular events.N Engl J Med.2014 Aug 14 ;371(7):612-23. doi : 10.1056/NEJMoa1311889.. 25119607

Sodium and cardiovascular disease.
N Engl J Med. 2014 Nov 27 ;371(22):2137-. doi : 1.1056/NEJMc141211.
Reference : O’Donnell M, Mente A, Yusuf S. Sodium and cardiovascular disease.N Engl J Med.2014 Nov 27 ;371(22):2137-8. doi : 10.1056/NEJMc1412113.. 25427117

Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension : a pooled analysis of data from four studies.
Lancet. 2016 Jul 30 ;388(10043):465-7. doi : 1.1016/S0140-6736(16)30467-. Epub 2016 May 2.
Reference : Mente A1, O’Donnell M2, Rangarajan S3, Dagenais G4, Lear S5, McQueen M6, Diaz R7, Avezum A8, Lopez-Jaramillo P9, Lanas F10, Li W11, Lu Y12, Yi S12, Rensheng L13, Iqbal R14, Mony P15, Yusuf R16, Yusoff K17, Szuba A18, Oguz A19, Rosengren A20, Bahonar A21, Yusufali A22, Schutte AE23, Chifamba J24, Mann JF25, Anand SS26, Teo K3, Yusuf S26 ; PURE, EPIDREAM and ONTARGET^?/TRANSCEND^? Investigators. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension : a pooled analysis of data from four studies.Lancet.2016 Jul 30 ;388(10043):465-75. doi : 10.1016/S0140-6736(16)30467-6. 27216139