Sex-specific patterns in the association between salt intake and blood pressure: The ELSA-Brasil study

J Clin Hypertens (Greenwich). 2019 Apr;21(4):502-509. doi: 10.1111/jch.13509. Epub 2019 Mar 12.


Blood pressure (BP) is a strong cardiovascular risk factor, predicting cardiovascular mortality in the general population. High salt consumption is a major contributor of increased BP and hypertension. However, there is a controversy on whether BP response to salt intake would be sex-specific. Thus, we aimed to verify the changes in BP according to different salt intake in men and women in a large sample of adults. The present analysis refers to 12 813 participants (from 35 to 64 years) with a validated 12-hour overnight urine collection in which salt intake was estimated. A set of questionnaires, clinical examination, and laboratory tests were carried out during a single visit to one of the six investigation centers involved. Salt intake was 12.9 ± 5.9 g/d in men and 9.3 ± 4.3 g/d in women. BP increases as salt intake increases, regardless of using BP-lowering medication. The slope of increase in BP elicited by salt intake was significantly higher in women than in men. Thus, the increase in BP by salt intake was stepper in women even after controlling for confounders, regardless of using BP-lowering medication or being hypertensive. In conclusion, salt intake is elevated in this large sample of Brazilian adults in which only a few participants are compliant with the recommendation. Also, women have a higher responsiveness of BP according to salt intake than men, and it is not associated with age, BP level, or the use of BP-lowering medication.

Keywords: hypertension; salt intake; salt sensitivity; sex differences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Pressure / physiology*
  • Brazil / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality
  • Cross-Sectional Studies
  • Eating / physiology*
  • Feeding Behavior / psychology
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Patient Compliance
  • Risk Factors
  • Sodium Chloride / urine
  • Sodium Chloride, Dietary / administration & dosage
  • Sodium Chloride, Dietary / adverse effects*
  • Urine Specimen Collection / methods


  • Sodium Chloride, Dietary
  • Sodium Chloride