However, the causes or related factors of hypertension may be different in Japanese and Americans. As for subjects aged 65 years or more, the prevalence was 69 % among Japanese and 70 % among Americans. According to national surveys, the prevalence of hypertension among 40 to 64-year-old Japanese men and women was 42 %, while the prevalence among 45 to 64-year-old US men and women was 41 %. The prevalence of hypertension has been reported to be similar between the Japanese and American populations. For the primary and secondary prevention of hypertension, the investigation of relationship between sodium intake or excretion with subsequent blood pressure changes among general populations is warranted. However, no prospective studies have evaluated the long-term effects of high sodium intake or excretion on subsequent blood pressure changes in general populations. A clinical experimental study of 14 normotensive men showed that an extreme sodium intake, 800 mmol/day (46.8 g/day salt intake) at three days increased systolic and diastolic blood pressure levels by 8 mmHg and 7 mmHg, respectively. Furthermore, a randomized controlled trial of individuals whose systolic blood pressure of 120 to 159 mmHg and/or diastolic blood pressure of 80 to 95 mmHg showed that the reduction in sodium intake from 150 to 50 mmol/day (8.8 to 2.9 g/day salt) lowered both systolic and diastolic blood pressure levels by 4.8 mmHg and 2.6 mmHg, respectively over the 90-day intervention. The relationship between sodium intake and blood pressure has been investigated since the 1900s and the associations between sodium intake/excretion and blood pressure levels have been studied mainly by using cross-sectional designs. High sodium concentrations in spot urine were associated with subsequent systolic blood pressure increases among non-overweight normotensive individuals. After further adjustment of baseline blood pressure levels, the association was slightly weakened the multivariable-adjusted mean values of the systolic blood pressure changes were +7.0 mmHg and +4.2 mmHg ( P for difference = 0.047, P for trend = 0.071). After adjustment for age, sex, BMI, alcohol intake status, current smoking and estimated glomerular filtration rate, the multivariable-adjusted mean values of the systolic blood pressure change among non-overweight subjects was +7.3 mmHg in the highest quartiles of sodium concentrations, while it was +3.9 mmHg in the lowest quartile ( P for difference = 0.021, P for trend = 0.040). When stratified by BMI at baseline survey, sodium concentrations were positively associated with systolic blood pressure changes in non-overweight subjects, but not in overweight subjects. Resultsįor all subjects, sodium concentrations in spot urine were not associated with either systolic or diastolic blood pressure changes. We examined the association between sodium concentration in spot urine, a validated index of sodium excretion occurring over 24-h, and blood pressure changes between baseline and follow-up survey in all, non-overweight (body mass index(BMI) ≤ 25 kg/m 2) and overweight normotensives. We conducted a prospective study of 889 normotensive subjects (295 men and 594 women, mean age 57.3 years) who underwent the baseline survey including spot urine test in 2005 and the follow-up survey in 2009 to 2011 (mean follow-up period: 5.8 years). Although several cross-sectional and intervention studies showed that sodium intake or excretion was associated with blood pressure levels, no prospective study has examined the long-term association between sodium excretion in spot urine and blood pressure changes.
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