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Abstract: TH-PO993

Dietary Counselling to Reduce Moderate Sodium Intake and Cardiovascular and Renal Biomarkers: Primary Findings of the COSIP and STICK Trials

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

  • Smyth, Andrew, National University of Ireland Galway, Galway, Galway, Ireland
  • Judge, Conor S., National University of Ireland Galway, Galway, Galway, Ireland
  • Griffin, Matthew D., National University of Ireland Galway, Galway, Galway, Ireland
  • Yusuf, Salim, Population Health Research Institute, Hamilton, Ontario, Canada
  • O'donnell, Martin, National University of Ireland Galway, Galway, Galway, Ireland
Background

While low sodium intake (<2.3g/day) is recommended, there is uncertainty about long-term feasibility and effects on biomarkers in those with moderate intake.

Methods

In two phase IIb randomised parallel, open-label, controlled, single-centre trials, individuals aged >40 years with stable blood pressure (BP), without heart failure or postural hypotension were randomised to an intensive dietary counselling intervention (target sodium <2.3g/day) or usual care. The STICK trial focused on chronic kidney disease (CKD); the COSIP trial excluded those with CKD or cardiovascular disease. All participants received healthy eating advice. Primary outcomes were NT-pro B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), C-reactive protein (CRP), renin, aldosterone and creatinine clearance (CrCl) at 2years.

Results

373 participants, with mean sodium excretion 3.1±1.5g/day, were randomised to intervention (n=187) or usual care (n=186). At 2 years, the intervention significantly reduced self-reported salt use (73% vs. 41%; p<0.001), but not 24-hour urine sodium (intervention -0.23g/day vs. usual care +0.05g/day, p=0.47). At 3 months, the intervention reduced BP (systolic -2.52mmHg, p=0.05; diastolic -1.92, p=0.02) and increased renin (+33.35 [95%CI 3.78-62.91]). At 2 years, there were no between-group differences in systolic BP (p=0.66,) diastolic BP (p=0.09), NT-proBNP (p=0.68), hsTnT (p=0.20), CRP (p=0.56), renin (p=0.52), aldosterone (p=0.61) or CrCl (p=0.68)(Figure).

Conclusion

Among individuals with moderate intake, intensive dietary counselling resulted in short-term reductions in sodium and BP, but no significant effects on cardiorenal biomarkers at two years. Our trial suggests it may not feasible to sustainably reduce sodium to guideline levels through intensive dietary counselling.

Funding

  • Government Support - Non-U.S.