{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:00:08Z","timestamp":1791828008666,"version":"4.3.4"},"reference-count":170,"publisher":"BMJ","license":[{"start":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T00:00:00Z","timestamp":1582502400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Systematic review and meta-analysis following PRISMA guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Ovid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Inclusion criteria<\/jats:title><jats:p>Randomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data extraction and analysis<\/jats:title><jats:p>Two of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>133 studies with 12\u2009197 participants were included. The mean reductions (reduced sodium<jats:italic>v<\/jats:italic>usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P&lt;0.001), 4.26 mm Hg (3.62 to 4.89, P&lt;0.001), and 2.07 mm Hg (1.67 to 2.48, P&lt;0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P&lt;0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days\u2019 duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p>PROSPERO CRD42019140812.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmj.m315","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T05:25:21Z","timestamp":1582608321000},"page":"m315","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":340,"title":["Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials"],"prefix":"10.1136","author":[{"given":"Liping","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Trieu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohei","family":"Yoshimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Neal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Woodward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norm R C","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T","family":"Lackland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl A M","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham A","family":"MacGregor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2807-4119","authenticated-orcid":false,"given":"Feng J","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,24]]},"reference":[{"key":"key20200302000053_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32203-7"},{"key":"key20200302000053_ref2","doi-asserted-by":"publisher","DOI":"10.1038\/nm1095-1009"},{"key":"key20200302000053_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.297.6644.319"},{"key":"key20200302000053_ref4","doi-asserted-by":"publisher","DOI":"10.1159\/000368508"},{"key":"key20200302000053_ref5","doi-asserted-by":"publisher","DOI":"10.1079\/NRR19890012"},{"key":"key20200302000053_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003733"},{"key":"key20200302000053_ref7","volume-title":"Guideline: Sodium intake for adults and children.","author":"World Health Organization","year":"2012"},{"key":"key20200302000053_ref8","volume-title":"Salt and health.","author":"Scientific Advisory Committee on Nutrition","year":"2003"},{"key":"key20200302000053_ref9","unstructured":"US Department of Health and Human Services and US Department of Agriculture. 2015-2020 Dietary guidelines for Americans. 8th Ed. https:\/\/health.gov\/dietaryguidelines\/2015\/guidelines."},{"key":"key20200302000053_ref10","volume-title":"Global action plan for the prevention and control of noncommunicable diseases 2013-2020: World Health Organization.","author":"World Health Organization","year":"2013"},{"key":"key20200302000053_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy384"},{"key":"key20200302000053_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004022.pub4"},{"key":"key20200302000053_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpu028"},{"key":"key20200302000053_ref14","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-018-0927-9"},{"key":"key20200302000053_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2018.11.010"},{"key":"key20200302000053_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy114"},{"key":"key20200302000053_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2014.10.009"},{"key":"key20200302000053_ref18","doi-asserted-by":"crossref","unstructured":"Newberry SJ, Chung M, Anderson CAM, et al. 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