ABC | Volume 114, Nº3, March 2020

Original Article Effects of added salt reduction on central and peripheral blood pressure Ana Carolina Arantes, 1,2 Ana Luiza Lima Sousa, 1,2 Priscila Valverde de O. Vitorino, 3 Paulo Cesar B. Veiga Jardim, 1, 2 Thiago de Souza Veiga Jardim, 1, 2 Jeeziane Marcelino Rezende, 1 Ellen de Souza Lelis, 3 Rafaela Bernardes Rodrigues, 1 Antonio Coca, 4 Weimar Kunz Sebba Barroso 1, 2 Universidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, 1 Goiânia, GO – Brazil Universidade Federal de Goiás - Liga de Hipertensão Arterial, 2 Goiânia, GO – Brazil Pontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, 3 Goiânia, Goiás – Brazil Universitat de Barcelona, 4 Barcelona – Spain Correspondência: Priscila Valverde de O. Vitorino • Pontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Av. Universitária, 1069. Postal Code 74605-010, Setor Universitário, Caixa Postal 86, Goiania, GO – Brazil E-mail: pvalverde@pucgoias.edu.br Manuscript received August 16, 2018, revised manuscript April 15, 20018, accepted May 15, 2018 DOI: https://doi.org/10.36660/abc.20180426 Abstract Background: Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. Objective: To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. Methods: This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual bloodpressuremeasurements and ambulatory bloodpressuremonitoringwere performed using the automatedOMRON 705CP device, and central blood pressure was measured using the Sphygmocor ® . Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. Results: A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39‑54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. Conclusion: The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561) Keywords: Cardiovascular Diseases; Arterial Pressure; Prehypertension; Hypertension; Sodium Chloride; Diet, Sodium‑Restricted; Health Policies Introduction Systemic arterial hypertension is one of the most prevalent cardiovascular risk factors, affecting nearly 970 million people in the world. It is the (direct or indirect) cause of more than nine million deaths every year, 1 accounting for 62% of the cases of cardiovascular diseases (CVD) and 49% of ischemic heart disease. 2 Prehypertension (PH) is also associated with increased incidence of CVD. 3,4 Compared with other methods of blood pressure (BP) measurement, casual BP measurement is inferior in predicting cardiovascular risk and shows lower diagnostic accuracy. 5,6 Ambulatory blood pressure monitoring (ABPM) has high diagnostic accuracy and excellent cost-benefit relationship. 7,8 Central blood pressure (CBP) provides information of more elastic, central arteries; it has lower values compared with casual pressure and is better associated with lesions in target organs. Therefore, CPB is the best predictor of cardiovascular events, 8 in addition to allowing the analysis of arterial stiffness and vascular resistance parameters. 9-12 Although the etiology of increased BP is multifactorial, excessive salt intake is a common and important factor. It causes elevations of BP levels and cardiovascular complications. Therefore, salt restriction is an important strategy for prevention and control of systemic arterial hypertension and CVD. 13,14 Mean daily amount of salt intake recommended is 5 g, or 2 g of sodium. However, Brazilians eat on average up to 12 g/day, i.e., more than the daily amount recommended. 15 Government policies of many countries have been implemented to reduce salt intake by 30% by the year of 2025 with the aim to reduce BP values in the population. 16 Assessment of salt intake, interventions for its reduction, and the use of instruments capable of identifying this reduction are important strategies in primary prevention of CVD. 554