Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association between blood pressure and dietary intakes of sodium and potassium among US adults using quantile regression analysis NHANES 2007–2014

Journal of Human Hypertension volume 34, pages 346–354 (2020)Cite this article

Subjects

Abstract

Hypertension has become a major public health challenge, and previous studies have observed associations between hypertension and sodium, potassium, and sodium to potassium ratio. However, little is known about how the whole continuum of blood pressure (BP) is related to dietary intake of sodium and potassium. This study aims to examine quantile-specific associations of blood pressure with dietary intake of sodium and potassium. It is based on national-level, cross sectional data for US adults aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 2007–2014. A total of 11,095 eligible subjects were included in this study. Quantile regression (QR) models were used to investigate distributional effects in the dietary intake of sodium and potassium on blood pressure by adjusting the confounding factors. We observed some evidence indicating distributional effects of dietary intake of sodium and potassium on systolic blood pressure (SBP) and diastolic blood pressure (DBP). QR showed that the consumption of sodium was positively associated with SBP (P10) and DBP (P10) in males, and positively associated with DBP (P80–P90) alone in females. Intake of potassium was, however, negatively associated with SBP (P20–P30, P70–P80) in males, and also negatively associated with SBP (P10–P80) and DBP(P20–P50) in females. Sodium to potassium ratio was positively associated with SBP (P10–P50, P80) and DBP (P70–P90) in males, and was positively associated with SBP(P10–P70, P90) in females. QR models provided a more detailed view on associations of SBP and DBP with the dietary intake of sodium and potassium and uncovered the quantile-related patterns.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yoon SS, Ostchega Y, Louis T. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999-2008. NCHS Data Brief. 2010;48:1–8.

    Google Scholar 

  2. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933–44.

    Article  Google Scholar 

  3. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension. 2015;65:54–61.

    Article  CAS  Google Scholar 

  4. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–360.

    PubMed  Google Scholar 

  5. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mmHg, 1990–2015. J Am Med Assoc. 2017;317:165–82.

    Article  Google Scholar 

  6. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet. 1997;349:1436–42.

    Article  CAS  Google Scholar 

  7. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    Article  Google Scholar 

  8. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–8.

    Article  Google Scholar 

  9. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2224–60.

    Article  Google Scholar 

  10. Elliott P, Walker LL, Little MP, Blair-West JR, Shade RE, Lee DR, et al. Change in salt intake affects blood pressure of chimpanzees: implications for human populations. Circulation. 2007;116:1563–8.

    Article  CAS  Google Scholar 

  11. Ducher M, Fauvel JP, Maurin M, Laville M, Maire P, Paultre CZ, et al. Sodium intake and blood pressure in healthy individuals. J Hypertens. 2003;21:289–94.

    Article  CAS  Google Scholar 

  12. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326.

    Article  Google Scholar 

  13. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013;346:f1325.

    Article  Google Scholar 

  14. Binia A, Jaeger J, Hu Y, Singh A, Zimmermann D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2015;33:1509–20.

    Article  CAS  Google Scholar 

  15. Sun X, Peng L, Manatunga A, Marcus M. Quantile regression analysis of censored longitudinal data with irregular outcome-dependent follow-up. Biometrics. 2016;72:64–73.

    Article  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention. The national health and nutrition examination survey. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhanes/index.htm

  17. Agricultural Research Service, Food Surveys Research Group. Food and nutrient database for dietary studies. Beltsville, MD: Agricultural Research Service, Food Surveys Research Group. https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-researchcenter/food-surveys-research-group/docs/fndds-download-databases/

  18. National Center for Health Statistics. National Health and Nutrition Examination Survey: Estimation procedures, 2011–2014. https://www.cdc.gov/nchs/data/series/sr_02/sr02_177.pdf

  19. National Center for Health Statistics. National Health and Nutrition Examination Survey: Estimation procedures, 2007–2010. https://www.cdc.gov/nchs/data/series/sr_02/sr02_159.pdf

  20. Koenker R, Bassett G. Regression quantiles. Econometrica. 1978;46:33–50.

    Article  Google Scholar 

  21. Do YK, Foo K, Ng YY, Ong ME. A quantile regression analysis of ambulance response time. Prehosp Emerg care. 2013;17:170–6.

    Article  Google Scholar 

  22. Zhang Z, Cogswell ME, Gillespie C, Fang J, Loustalot F, Dai S, et al. Association between usual sodium and potassium intake and blood pressure and hypertension among US adults: NHANES 2005–2010. PLoS ONE. 2013;8:e75289.

    Article  CAS  Google Scholar 

  23. Stolarz-Skrzypek K, Liu Y, Thijs L, Kuznetsova T, Czarnecka D, Kawecka-Jaszcz K, et al. Blood pressure, cardiovascular outcomes and sodium intake, a critical review of the evidence. Acta Clin Belg. 2012;67:403–10.

    CAS  PubMed  Google Scholar 

  24. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013;346:f1325.

    Article  Google Scholar 

  25. Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, et al. Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr. 2012;96:647–57.

    Article  CAS  Google Scholar 

  26. US Department of Health and Human Services; US Department of Agriculture. Dietary Guidelines for Americans 2015–2020 8th ed. https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

  27. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121:586–613.

    Article  Google Scholar 

  28. Noh HM, Park SY, Lee HS, Oh HY, Paek YJ, Song HJ, et al. Association between high blood pressure and intakes of sodium and potassium among korean adults: Korean National Health and Nutrition Examination Survey, 2007–2012. J Acad Nutr Diet. 2015;115:1950–7.

    Article  Google Scholar 

  29. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol. 2015;61:1–17.

    Article  Google Scholar 

  30. He J, Gu D, Chen J, Jaquish CE, Rao DC, Hixson JE, et al. Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study. J Hypertens. 2009;27:48–54.

    Article  CAS  Google Scholar 

  31. Pecins-Thompson M, Keller-Wood M. Effects of progesterone on blood pressure, plasma volume, and responses to hypotension. Am J Physiol. 1997;272(1 Pt 2):R377–85.

    CAS  PubMed  Google Scholar 

  32. Stachenfeld NS, Keefe DL, Taylor HS. Responses to a saline load in gonadotropin-releasing hormone antagonist-pretreated premenopausal women receiving progesterone or estradiol-progesterone therapy. J Clin Endocrinol Metab. 2005;90:386–94.

    Article  CAS  Google Scholar 

  33. Montasser ME, Shimmin LC, Gu D, Chen J, Gu C, Kelly TN, et al. Blood pressure response to potassium supplementation is associated with genetic variation in endothelin 1 and interactions with E selectin in rural Chinese. J Hypertens. 2010;28:748–55.

    Article  CAS  Google Scholar 

  34. Chu C, Wang Y, Ren KY, Yan DY, Guo TS, Zheng WL, et al. Genetic variants in adiponectin and blood pressure responses to dietary sodium or potassium interventions: a family-based association study. J Hum Hypertens. 2016;30:563–70.

    Article  CAS  Google Scholar 

  35. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 h urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ. 1988;297:319–28.

  36. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. J Am Med Assoc. 2011;305:1777–85.

    Article  CAS  Google Scholar 

  37. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr., et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839–46.

    Article  CAS  Google Scholar 

  38. Nishi EE, Bergamaschi CT, Campos RR. The crosstalk between the kidney and the central nervous system: the role of renal nerves in blood pressure regulation. Exp Physiol. 2015;100:479–84.

    Article  Google Scholar 

  39. Rocchini AP, Key J, Bondie D, Chico R, Moorehead C, Katch V, et al. The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. New Engl J Med. 1989;321:580–5.

    Article  CAS  Google Scholar 

  40. Wadei HM, Textor SC. The role of the kidney in regulating arterial blood pressure. Nat Rev Nephrol. 2012;8:602–9.

    Article  CAS  Google Scholar 

  41. Ellison DH, Terker AS. Why your mother was right: how potassium intake reduces blood pressure. Trans Am Clin Climatol Assoc. 2015;126:46–55.

    PubMed  PubMed Central  Google Scholar 

  42. Chmielewski J, Carmody JB. Dietary sodium, dietary potassium, and systolic blood pressure in US adolescents. J Clin Hypertens. 2017;19:904–9.

    Article  CAS  Google Scholar 

  43. Lerchl K, Rakova N, Dahlmann A, Rauh M, Goller U, Basner M, et al. Agreement between 24-h salt ingestion and sodium excretion in a controlled environment. Hypertens. 2015;66:850–7.

    Article  CAS  Google Scholar 

  44. Cohen JFW, Lehnerd ME, Houser RF, Rimm EB. Dietary approaches to stop hypertension diet, weight status, and blood pressure among children and adolescents: National Health and Nutrition Examination Surveys 2003–2012. J Acad Nutr Diet. 2017;117:1437–1444.e2.

    Article  Google Scholar 

  45. Beyerlein A. Quantile regression-opportunities and challenges from a user’s perspective. Am J Epidemiol. 2014;180:330–1.

    Article  Google Scholar 

Download references

Funding

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 130021, Changchun, China

    Meng Li, Shoumeng Yan, Shan Jiang, Xiaoyu Ma, Hantong Zhao, Jiagen Li, Chong Sun, Lina Jin, Yan Yao & Bo Li

  2. Department of Quality Control, the Affiliated Hospital to Changchun University of Chinese Medicine, 130021, Changchun, China

    Xing Li

Authors
  1. Meng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shoumeng Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shan Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaoyu Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hantong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiagen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chong Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lina Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yan Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yan Yao or Bo Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, M., Yan, S., Li, X. et al. Association between blood pressure and dietary intakes of sodium and potassium among US adults using quantile regression analysis NHANES 2007–2014. J Hum Hypertens 34, 346–354 (2020). https://doi.org/10.1038/s41371-019-0224-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-019-0224-9

This article is cited by

Search

Advanced search

Quick links