BACKGROUND Both blood pressure-lowering medication and sodium reduction are effective in hypertension control, but whether the effect of sodium reduction differ across blood pressure-lowering medications is unclear. This study aims to evaluate the dose-response effect of sodium intake reduction on blood pressure in treated hypertensive individuals and the impact of different classes of blood pressure-lowering drugs. METHODS We searched multiple databases and reference lists up to July 9, 2024. Randomized controlled trials with a duration of ≥2 weeks comparing the effect of different levels of sodium intake (measured by 24-hour urinary sodium excretion) on blood pressure in hypertensive individuals treated with constant blood pressure-lowering medications were included. Instrumental variable meta-analyses based on random-effects models were conducted to evaluate the dose effect of sodium reduction on blood pressure. Subgroup analyses were performed based on the class of blood pressure-lowering drugs, age, baseline sodium and blood pressure levels, and study duration. RESULTS We included 35 studies (median duration of 28 days) with a total of 2885 participants. For every 100 mmol reduction in 24-hour urinary sodium excretion, systolic blood pressure decreased by 6.81 mm Hg (95% CI, 4.96-8.66), diastolic blood pressure decreased by 3.85 mm Hg (95% CI, 2.26-5.43), and mean arterial pressure decreased by 4.83 mm Hg (95% CI, 3.22-6.44). The dose-response effects varied across classes of blood pressure-lowering medications, with greater effects observed in the β-blockers, renin-angiotensin-aldosterone system inhibitors, and dual therapy groups. No significant subgroup differences were observed across subgroups defined by age, baseline 24-hour urinary sodium excretion, blood pressure levels, or study duration. CONCLUSIONS Pooled evidence suggests a dose-response relationship between sodium reduction and blood pressure in treated individuals with hypertension, influenced by the class of blood pressure-lowering medications.

中文翻译：

---

降血压药物、降钠和血压。


背景 降血压药物和降钠对高血压控制均有效，但降钠效果是否因降血压药物而异尚不清楚。本研究旨在评估减少钠摄入量对接受治疗的高血压个体血压的剂量反应效应以及不同类别降压药物的影响。方法 我们检索了多个数据库和参考文献列表，检索时间截至 2024 年 7 月 9 日。纳入持续时间为 ≥2 周的随机对照试验，比较不同水平钠摄入量（通过 24 小时尿钠排泄量测量）对接受持续降血压药物治疗的高血压个体血压的影响。进行基于随机效应模型的仪器变量荟萃分析，以评估减钠对血压的剂量影响。根据降血压药物的类别、年龄、基线钠和血压水平以及研究持续时间进行亚组分析。结果：我们纳入了 35 项研究（中位持续时间为 28 天），共涉及 2885 名受试者。24 小时尿钠排泄量每减少 100 mmol，收缩压降低 6.81 mm Hg（95% CI，4.96-8.66），舒张压降低 3.85 mm Hg（95% CI，2.26-5.43），平均动脉压降低 4.83 mm Hg（95% CI，3.22-6.44）。剂量反应效应因降压药物类别而异，在β阻滞剂、肾素-血管紧张素-醛固酮系统抑制剂和双重治疗组中观察到更大的效果。 在由年龄、基线 24 小时尿钠排泄、血压水平或研究持续时间定义的亚组中未观察到显著的亚组差异。结论 汇总证据表明，受降压药物类别的影响，接受治疗的高血压患者钠减少与血压之间存在剂量反应关系。