Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride

Cochrane Database Syst Rev. 2011 Nov 9;(11):CD004022. doi: 10.1002/14651858.CD004022.pub3.


Background: In spite of more than 100 years of investigations the question of reduced sodium intake as a health prophylaxis initiative is still unsolved.

Objectives: To estimate the effects of low sodium versus high sodium intake on systolic and diastolic blood pressure (SBP and DBP), plasma or serum levels of renin, aldosterone, catecholamines, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides.

Search methods: PUBMED, EMBASE and Cochrane Central and reference lists of relevant articles were searched from 1950 to July 2011.

Selection criteria: Studies randomizing persons to low sodium and high sodium diets were included if they evaluated at least one of the above outcome parameters.

Data collection and analysis: Two authors independently collected data, which were analysed with Review Manager 5.1.

Main results: A total of 167 studies were included in this 2011 update.The effect of sodium reduction in normotensive Caucasians was SBP -1.27 mmHg (95% CI: -1.88, -0.66; p=0.0001), DBP -0.05 mmHg (95% CI: -0.51, 0.42; p=0.85). The effect of sodium reduction in normotensive Blacks was SBP -4.02 mmHg (95% CI:-7.37, -0.68; p=0.002), DBP -2.01 mmHg (95% CI:-4.37, 0.35; p=0.09). The effect of sodium reduction in normotensive Asians was SBP -1.27 mmHg (95% CI: -3.07, 0.54; p=0.17), DBP -1.68 mmHg (95% CI:-3.29, -0.06; p=0.04). The effect of sodium reduction in hypertensive Caucasians was SBP -5.48 mmHg (95% CI: -6.53, -4.43; p<0.00001), DBP -2.75 mmHg (95% CI: -3.34, -2.17; p<0.00001). The effect of sodium reduction in hypertensive Blacks was SBP -6.44 mmHg (95% CI:-8.85, -4.03; p=0.00001), DBP -2.40 mmHg (95% CI:-4.68, -0.12; p=0.04). The effect of sodium reduction in hypertensive Asians was SBP -10.21 mmHg (95% CI:-16.98, -3.44; p=0.003), DBP -2.60 mmHg (95% CI: -4.03, -1.16; p=0.0004).In plasma or serum there was a significant increase in renin (p<0.00001), aldosterone (p<0.00001), noradrenaline (p<0.00001), adrenaline (p<0.0002), cholesterol (p<0.001) and triglyceride (p<0.0008) with low sodium intake as compared with high sodium intake. In general the results were similar in studies with a duration of at least 2 weeks.

Authors' conclusions: Sodium reduction resulted in a 1% decrease in blood pressure in normotensives, a 3.5% decrease in hypertensives, a significant increase in plasma renin, plasma aldosterone, plasma adrenaline and plasma noradrenaline, a 2.5% increase in cholesterol, and a 7% increase in triglyceride. In general, these effects were stable in studies lasting for 2 weeks or more.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • African Continental Ancestry Group
  • Aldosterone / blood
  • Asian Continental Ancestry Group
  • Blood Pressure / drug effects*
  • Blood Pressure / radiation effects
  • Catecholamines / blood
  • Cholesterol / blood
  • Diet, Sodium-Restricted*
  • European Continental Ancestry Group
  • Humans
  • Hypertension / diet therapy*
  • Hypertension / ethnology
  • Randomized Controlled Trials as Topic
  • Renin / blood
  • Sodium Chloride, Dietary / pharmacology*
  • Triglycerides / blood


  • Catecholamines
  • Sodium Chloride, Dietary
  • Triglycerides
  • Aldosterone
  • Cholesterol
  • Renin