J Korean Med Sci. 2013;28(7):1034-40.

Small increases in plasma sodium are associated with higher risk of mortality in a healthy population.

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제1저자 오세원 · 교신저자 진호준

PMID 23853486 PMC3708074 DOI 10.3346/jkms.2013.28.7.1034 IF 3.2 신장내과

소속 (1)

Division of Nephrology, Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.

Abstract

Elevated blood pressure (BP) is the most common cause of cardiovascular disease. Salt intake has a strong influence on BP, and plasma sodium (pNa) is increased with progressive increases in salt intake. However, the associations with pNa and BP had been reported inconsistently. We evaluated the association between pNa and BP, and estimated the risks of all-cause-mortality according to pNa levels. On the basis of data collected from health checkups during 1995-2009, 97,009 adult subjects were included. Positive correlations between pNa and systolic BP, diastolic BP, and pulse pressure (PP) were noted in participants with pNa ≥138 mM/L (P<0.001). In participants aged ≥50 yr, SBP, DBP, and PP were positively associated with pNa. In participants with metabolic syndrome components, the differences in SBP and DBP according to pNa were greater (P<0.001). A cumulative incidence of mortality was increased with increasing pNa in women aged ≥50 yr during the median 4.2-yr-follow-up (P<0.001). In women, unadjusted risks for mortality were increased according to sodium levels. After adjustment, pNa ≥145 mM/L was related to mortality. The positive correlation between pNa and BP is stronger in older subjects, women, and subjects with metabolic syndrome components. The incidence and adjusted risks of mortality increase with increasing pNa in women aged ≥50 yr.

Keywords

AgeBlood PressureMortalityPlasma SodiumSex Characteristics

Figures

**Fig. 1** Distribution of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressue (PP) according to plasma sodium (pNa) levels. (A) SBP according to pNa levels. SBP in participants with pNa ≥ 141 mM/L was significantly higher than in pNa 138-139 mM/L (P = 0.002), and SBP was not significantly different among participants with pNa < 134 and pNa 138-139 mM/L. The SBP is adjusted by age, estimated glomerular filtration rate, body mass index, total serum cholesterol, protein, calcium, phosphorus, glucose, potassium, HDL cholesterol, and alkaline phosphatase using co-variance analysis (ANCOVA). Error bars indicate the standard error of the mean. (B) DBP according to pNa levels. DBP in participants with pNa ≥ 141 mM/L was significantly higher than in participants with pNa 138-139 mM/L (P < 0.001). The DBP is adjusted by age, estimated glomerular filtration rate, body mass index, total serum cholesterol, protein, calcium, phosphorus, glucose, potassium, HDL cholesterol, and alkaline phosphatase using co-variance analysis (ANCOVA). Error bars indicate the standard error of the mean. (C) PP according to pNa levels. Only pulse pressure (PP) in pNa ≥ 145 mM/L participants was significantly higher than in pNa 138-189 mM/L participants. The PP is adjusted by age, estimated glomerular filtration rate, body mass index, total serum cholesterol, protein, calcium, phosphorus, glucose, potassium, HDL cholesterol, and alkaline phosphatase using co-variance analysis (ANCOVA). Error bars indicate the standard error of the mean. ^*P < 0.05 vs participants with pNa 138-140 mM/L.

**Fig. 2** The distribution of systolic blood pressure (SBP) according to sodium groups stratified by age and gender. The SBP is adjusted by age, estimated glomerular filtration rate, body mass index, serum total cholesterol, protein, calcium, phosphorous, glucose, potassium, HDL cholesterol, and alkaline phosphatase using co-variance analysis (ANCOVA). Error bars indicate the standard error of the mean. ^*P < 0.05 vs participants with pNa 138-140 mM/L.

**Fig. 3** The distribution of systolic blood pressure (SBP) according to sodium groups in participants with and without components of metabolic syndrome. The SBP is adjusted by age, estimated glomerular filtration rate, body mass index, serum total cholesterol, protein, calcium, phosphorous, glucose, potassium, HDL cholesterol, and alkaline phosphatase using co-variance analysis (ANCOVA). Error bars indicate the standard error of the mean. ^*P < 0.05 vs participants with pNa 138-140 mM/L.

**Fig. 4** Survival curves for all-cause mortality of all participants and women aged ≥ 50 yr according to sodium groups. (A) All participants. The participants were categorized according to plasma sodium: group 1, 138-140 mM/L; group 2, 141-142 mM/L; group 3, 143-144 mM/L; and group 4, ≥ 145 mM/L. (B) Women aged ≥ 50 yr.

그림 출처: PubMed Central 공개 논문 (PMC3708074)

Conflict of interest statement

The authors declare no conflicts of interest.

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