ABC | Volume 113, Nº3, September 2019

Original Article Villela et al. Salt preference and hypertension Arq Bras Cardiol. 2019; 113(3):392-399 Contrary to our hypothesis, we found no relationship between sodium intake and age , BMI or tobacco use, but sodium intake was significantly higher among volunteers who consumed alcohol. These volunteers preferred saltier samples and showed an average larger amount of sodium excretion in 24hour urine, in agreement with data reported by Gibson & Margaret 28 who showed that high alcohol intake is one of the major features among high salt consumers. It is important to note that one of the exclusion criteria for the present study was alcohol abuse so that the effect of alcohol on salt preference could have been underestimated if individuals with greater consumption had been included. Alcohol consumption has been associated with increased BP and an increased risk of hypertension in many observational studies and clinical trials, demonstrating that these associations are causal. 29 Hypertensive volunteers had higher mean BP and higher average urinary sodium excretion compared to normotensive volunteers, in agreement with the association between increased sodium excretion and increased arterial BP reported in several studies. 19,20,30,31 Thus, it was observed that hypertensive patients had higher mean BP even when treated, with a greater preference for salt intake and with higher urinary sodium excretion compared to normotensive subjects. These results support recommendations for the reduction of high salt intake in the population for prevention and control of adverse BP levels. 20 Despite the small percentage of smokers included in this study (9.3%), no significant differences were identified as to their preferences. Recent research in Germany has shown that smoking did not present a risk to gustatory commitment, although food preferences were not compared and the average age of individuals who participated in the study was 56 years. 32 For potassium intake, the present study found increased urinary potassium excretion in the hypertensive groups, in contrast to the study of Galletti et al., 33 which showed low potassium excretion in 24hour urine in 1232 hypertensive Italians from 47 volunteer centers of the Italian Society of Hypertension. Observational studies have shown an inverse relationship between potassium intake and BP. 19 The electrolyte excretion in 24-hour urine analysis and BP in the INTERSALT study 19 showed that potassium excretion was negatively correlated with BP. Cappuccio et al. 34 performed a meta-analysis of 19 studies with oral potassium supplementation involving 586 participants. The results showed that oral potassium supplementation significantly reduced both systolic and diastolic BP and that reductions in BP were higher in hypertensive patients than in normotensive individuals. Perhaps the finding in the present investigation differing from other studies could be explained by the fact that the volunteers had been regularly monitored at a secondary level health center for many years, having received nutritional guidance regarding a balanced diet rich in fruits and vegetables, and greater potassium intake. It is important to emphasize that this study did not evaluate long-term adherence to bread with oregano, only preference in a tasting test in a small sample. A larger, longer, and randomized clinical trial is needed to confirm the benefits of an intervention contributing to the reduction of daily sodium intake, by adding spice to food. The volunteers were followed up at a public health center, not being able to extrapolate the results to different populations. Conclusions The present study demonstrated a greater preference for salt and more salt consumption in hypertensive than normotensive individuals regardless of age. The intervention of adding oregano to food led to a preference for samples with lower salt content in all groups, i.e., hypertensive, normotensive, young or old subjects. A higher preference for salt was found to be associated with male gender and alcohol consumption. Author contributions Conception and design of the research and Writing of the manuscript: Villela PTM, Moriguti JC, Lima NKC; Acquisition of data: Villela PTM, de-Oliveira EB, Villela PTM, Bonardi JMT, Bertani RF; Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: Villela PTM, de-Oliveira EB, Villela PTM, Bonardi JMT, Bertani RF, Moriguti JC, Ferriolli E, Lima NKC; Statistical analysis and Obtaining financing: Ferriolli E, Lima NKC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Abbot Vascular. Study Association This article is part of the thesis of Doctoral submitted by Patrícia Teixeira Meirelles Villela, from Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo under the protocol number 464. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 397