Excessive dietary sodium intake and elevated blood pressure: a review of current prevention and management strategies and the emerging role of pharmaconutrigenetics

Sodium is an electrolyte that is involved in vital physiological processes, including muscle and nerve function by controlling membrane potential of cells, active transport of molecules across cell membranes and controlling blood pressure through altering fluid and electrolyte balance in the body.4 Low sodium intake may affect insulin resistance, blood lipids, CVD risk and increase plasma renin activity, although more evidence is needed to substantiate these adverse events.4 Excessive intake of sodium is strongly associated with elevated blood pressure, which increases the risk for cardiovascular and renal diseases.4 Raised blood pressure and hypertension are major risk factors for CVD as they are underlying contributing factors in 62% of all stroke events and 49% of all coronary heart disease cases.5 At the global level, the prevalence of raised blood pressure affects 40% of adults aged 25 years and older and accounts for 12.8% of all deaths.6 In the USA, approximately one-third of the adult population suffers from hypertension with 76% taking medication to manage the disease.7 Hypertension is prevalent in 7.3% of adults aged 18 years and over, 32.4% of adults aged 40–59 years and 65% of adults aged 60 years and older.7 Proper blood pressure control is critical in avoiding cardiovascular-related mortality and remains an area of great public health concern. For the past 40 years, heart disease has remained the top leading cause of mortality in the USA (23.4% of all deaths).8 In 2015, stroke was ranked as the fifth cause of mortality in the USA (5.2% of all deaths).8 Maintaining an optimal level of sodium intake can help manage blood pressure and prevent cardiovascular-related mortality since studies have shown that reducing sodium consumption can reduce blood pressure.9 Given these data, it is imperative that healthcare professionals and public health efforts aim to ensure sodium intake among the population is within a healthy range. Table 2 4 summarises the dietary reference intake (DRI) levels, including the AI and tolerable ULs of sodium set by the Institute of Medicine for the US population, which are similar to the guidelines recommended for Canadians.11 12 In line with these DRI levels, the 2015–2020 Dietary Guidelines for Americans recommends that adults limiting sodium intake to less than 2.3 g per day as part of a healthy eating pattern.13 The WHO recommends a level of sodium intake less than 2 g per day for adults in order to reduce blood pressur