Trial reportJournal of the American College of Cardiology2016
Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention.
Trial report in Journal of the American College of Cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 126 papers, 10 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
126 citing papers in PubMed, 10 syntheses or guidelines pooled it.
- Systematic Review of Social Marketing as a Behavior Change Agent in Salt Reduction.Global heart · 2025Pooled it
- Cystic Fibrosis Foundation Evidence-Based Guideline for the Management of CRMS/CFSPID.Pediatrics · 2024Guideline
- Pooled it
- Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019.Advances in nutrition (Bethesda, Md.) · 2020Pooled it
- A Systematic Review of the Sources of Dietary Salt Around the World.Advances in nutrition (Bethesda, Md.) · 2020Pooled it
- Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019.Arquivos brasileiros de cardiologia · 2019Guideline
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019Guideline
- Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map.Annals of internal medicine · 2019Pooled it
- Dose-response association of dietary sodium intake with all-cause and cardiovascular mortality: a systematic review and meta-analysis of prospective studies.Public health nutrition · 2019Pooled it
- High sodium intake increases blood pressure and risk of kidney disease. From the Science of Salt: A regularly updated systematic review of salt and health outcomes (August 2016 to March 2017).Journal of clinical hypertension (Greenwich, Conn.) · 2018Pooled it
- Sex-dependent modulation of T and NK cells and gut microbiome by low sodium diet in patients with primary aldosteronism.Frontiers in immunology · 2024Trial
- High dietary salt intake increases urinary NGAL excretion and creatinine clearance in healthy young adults.American journal of physiology. Renal physiology · 2022Trial
- Trial
- Validation of preferred salt concentration in soup based on a randomized blinded experiment in multiple regions in Japan-influence of umami (L-glutamate) on saltiness and palatability of low-salt solutions.Hypertension research : official journal of the Japanese Society of Hypertension · 2020Trial
- High Salt Intake Augments Blood Pressure Responses During Submaximal Aerobic Exercise.Journal of the American Heart Association · 2020Trial
- Reducing Dietary Sodium to 1000 mg per Day Reduces Neurovascular Transduction Without Stimulating Sympathetic Outflow.Hypertension (Dallas, Tex. : 1979) · 2019Trial
- Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health.International journal of epidemiology · 2018Trial
- Trial
- Time-varying eating behaviors and long-term risk of incident hypertension in a Japanese cohort.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Development of a Low-Sodium Soaking Solution for Shrimp Processing Using Potassium Phosphates (KTPP and TKPP) and L-Lysine: Impacts on Quality and Water-Holding Capacity.Foods (Basel, Switzerland) · 2026Article
66 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundThe relationship between lower sodium intake and total mortality remains controversial.
objectivesThis study examined the relationship between well-characterized measures of sodium intake estimated from urinary sodium excretion and long-term mortality.
methodsTwo trials, phase I (1987 to 1990), over 18 months, and phase II (1990 to 1995), over 36 months, were undertaken in TOHP (Trials of Hypertension Prevention), which implemented sodium reduction interventions. The studies included multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age during the trials. Post-trial deaths were ascertained over a median 24 years, using the National Death Index. The associations between mortality and the randomized interventions as well as with average sodium intake were examined.
resultsAmong 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.66 to 1.09; p = 0.19). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred. There was a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend = 0.30) for <2,300, 2,300 to <3,600, 3,600 to <4,800, and ≥4,800 mg/24 h, respectively; and with an HR of 1.12 per 1,000 mg/24 h (95% CI: 1.00 to 1.26; p = 0.05). There was no evidence of a J-shaped or nonlinear relationship. The HR per unit increase in sodium/potassium ratio was 1.13 (95% CI: 1.01 to 1.27; p = 0.04).
conclusionsWe found an increased risk of mortality for high-sodium intake and a direct relationship with total mortality, even at the lowest levels of sodium intake. These results are consistent with a benefit of reduced sodium and sodium/potassium intake on total mortality over a 20-year period.
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