Salt Reduction to Prevent Hypertension and Cardiovascular Disease

There is strong evidence for a causal relationship between salt intake and blood pressure. Randomized trials demonstrate that salt reduction lowers blood pressure in both individuals who are hypertensive and those who are normotensive, additively to antihypertensive treatments. Methodologically robust studies with accurate salt intake assessment have shown that a lower salt intake is associated with a reduced risk of cardiovascular disease, all-cause mortality, and other conditions, such as kidney disease, stomach cancer, and osteoporosis. Multiple complex and interconnected physiological mechanisms are implicated, including fluid homeostasis, hormonal and inflammatory mechanisms, as well as more novel pathways such as the immune response and the gut microbiome. High salt intake is a top dietary risk factor. Salt reduction programs are cost-effective and should be implemented or accelerated in all countries. This review provides an update on the evidence relating salt to health, with a particular focus on blood pressure and cardiovascular disease, as well as the potential mechanisms. • Our current high salt intake is among the top 3 dietary risk factors worldwide. • Population-wide reduction in salt intake lowers population BP and alleviates the burden of CVD and other chronic diseases. • Paradoxical findings from methodologically flawed studies should not be used to refute the strong evidence on the benefits of salt reduction. • Worldwide salt-reduction efforts should be reinforced to save millions of people dying unnecessarily from stroke and heart disease each year.