Impact of self-monitoring of salt intake by salt meter in hypertensive patients: A randomized controlled trial (SMAL-SALT)

Effectiveness of self-monitoring devices measuring the urinary sodium-to-potassium ratio, urinary salt (sodium) excretion, or salt concentration in foods for blood pressure management: a systematic review and meta-analysis

Self-monitoring devices that measure the urinary sodium-to-potassium (Na/K) ratio, urinary salt or sodium excretion, or salt concentration in foods have emerged as tools that can guide dietary adjustments for blood pressure (BP) control. This systematic review and meta-analysis investigated whether these self-monitoring devices can help to control BP in adults. The PubMed, Cochrane Library, and Ichushi-Web databases were searched to identify randomized controlled trials that compared the effect of these devices (with or without additional dietary education) plus usual care on BP with that of usual care alone. The pooled effect of weighted mean difference between the intervention and control groups at the end of follow-up was estimated by random-effects meta-analysis. The primary outcome was the change in BP. Secondary outcomes included changes in the urinary Na/K ratio, and sodium and potassium excretions. Of 1525 studies screened, eight (with 1442 participants) were eligible for inclusion. Meta-analysis showed greater reductions in systolic BP by 2.45 (95% confidence interval, 0.04, 4.86) mmHg and diastolic BP by 1.38 (-0.15, 2.90) mmHg in the intervention vs. control groups. However, heterogeneity was high (I² = 69.4% for systolic BP and 65.1% for diastolic BP). The BP-lowering effect was not statistically different across different follow-up durations (4 weeks or 2-6 months) and intervention approaches (self-monitoring alone or combined with dietary education) (all p values for heterogeneity >0.1). Reductions in the urinary Na/K ratio and sodium excretion were greater in the intervention group. Self-monitoring devices may assist with BP reduction by promoting decreased sodium intake and increased potassium intake.

Community-based intervention for monitoring of salt intake in hypertensive patients: A cluster randomized controlled trial

BACKGROUND

Excessive sodium intake is associated with high blood pressure and an increased risk of cardiovascular disease. However, reducing dietary salt has been challenging due to a lack of awareness and a high threshold in detecting saltiness.

OBJECTIVES

The goal of this study is to evaluate the effectiveness of a combined intervention (intensive dietary education, food reformulation, environmental changes to facilitate salt reduction, and salt meter utilization), in comparison to standard education only, on salt intake and blood pressure.

METHODS

A cluster randomized-controlled trial was conducted on 219 hypertensive adults aged 18 to 70 years in Uthaithani, Thailand. Participants were randomized 1:1 into the intervention group (n = 111) and the control group (n = 108).

RESULTS

There were no differences in baseline characteristics between groups. The mean systolic and diastolic blood pressure was 143.6 and 82.1 mmHg and 142.2 and 81.4 mmHg in the intervention group, and the control group, respectively. The median 24-hour urinary sodium excretion was 3565 and 3312 mg/day, in the intervention and the control group, respectively. After 12 weeks, the change in systolic blood pressure was -13.5 versus -9.5 mmHg (P = 0.030) and diastolic blood pressure was -6.4 versus -4.8 mmHg (P = 0.164) in the intervention and control groups, respectively. Moreover, a reduction in 24-hour urine sodium excretion was observed [-575 versus -299 mg/day in the intervention and control groups, respectively (P = 0.194)]. The change in 24-hour urine sodium excretion was statistically significant and reduced from baseline in the intervention group (P = 0.004). The dietary salt intake was significantly improved and was statistically different between groups (P = 0.035).

CONCLUSIONS

The combined intervention significantly decreased systolic blood pressure and showed a trend towards reduced urine sodium excretion in hypertensive patients. These comprehensive approaches may be beneficial in reducing blood pressure and salt intake in the community.

CLINICAL TRIAL REGISTRATION

This trial was registered at Clinicaltrials.gov with the identifier NCT05397054. https://classic.clinicaltrials.gov/ct2/show/NCT05397054.

Barriers and Facilitators to Dietary Salt Reduction Among Patients With Hypertension in Southern Nigeria: A Hospital-based Qualitative Study

Introduction

Reduction in salt intake improves blood pressure control and reduces the risk of hypertension and other noncommunicable diseases (NCDs). However, salt intake remains high among Nigerians. This study aimed to identify barriers and facilitators to salt reduction among hypertensive patients attending a family medicine clinic in southern Nigeria.

Methodology

A focussed group discussion (FGD) exploring patients' perceptions of the barriers and facilitators to salt reduction was conducted with 8 groups of purposefully selected 74 hypertensives who consumed excess dietary salt, stratified by age and sex, using an FGD guide. Thematic analysis was then performed using Nvivo® version 12 pro. Ethical approval was obtained from Irrua Specialist Teaching Hospital (ISTH), and written informed consent was obtained from the patients before the FGD.

Results

Respondents had a mean age of 51.96 ± 8.98 years. The majority were females (47, 63.5%) and had uncontrolled blood pressure (66, 89.2%). Five major themes were identified, from which several minor themes emerged. Respondents rated their overall health as good but expressed concerns about their poor blood pressure control. Identified barriers to salt reduction included family pressure, ignorance, ready availability and affordability of salt and lack of affordable alternatives. Facilitators of salt reduction were measuring the amount of cooking salt, removing salt from the dining table and providing substitutes. Respondents, however, expressed willingness to reduce their salt consumption.

Conclusion

The study identified barriers and facilitators to salt reduction. There is a need to create awareness of the safe amount of salt to be consumed and provide safe and readily available alternatives.

Technology-supported behavior change interventions for reducing sodium intake in adults: a systematic review and meta-analysis

The effects of technology-supported behavior change interventions for reducing sodium intake on health outcomes in adults are inconclusive. Effective intervention characteristics associated with sodium reduction have yet to be identified. A systematic review and meta-analysis were conducted, searching randomized controlled trials (RCTs) published between January 2000 and April 2023 across 5 databases (PROSPERO: CRD42022357905). Meta-analyses using random-effects models were performed on 24-h urinary sodium (24HUNa), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Subgroup analysis and meta-regression of 24HUNa were performed to identify effective intervention characteristics. Eighteen RCTs involving 3505 participants (51.5% female, mean age 51.6 years) were included. Technology-supported behavior change interventions for reducing sodium intake significantly reduced 24HUNa (mean difference [MD] -0.39 gm/24 h, 95% confidence interval [CI] -0.50 to -0.27; I2 = 24%), SBP (MD -2.67 mmHg, 95% CI -4.06 to -1.29; I2 = 40%), and DBP (MD -1.39 mmHg, 95% CI -2.31 to -0.48; I2 = 31%), compared to control conditions. Interventions delivered more frequently (≤weekly) were associated with a significantly larger effect size in 24HUNa reduction compared to less frequent interventions (>weekly). Other intervention characteristics, such as intervention delivery via instant messaging and participant-family dyad involvement, were associated with larger, albeit non-significant, effect sizes in 24HUNa reduction when compared to other subgroups. Technology-supported behavior change interventions aimed at reducing sodium intake were effective in reducing 24HUNa, SBP, and DBP at post-intervention. Effective intervention characteristics identified in this review should be considered to develop sodium intake reduction interventions and tested in future trials, particularly for its long-term effects.

Relationships between illness perception, functional status, social support, and self-care behavior among Thai people at high risk of stroke: A cross-sectional study

Background

People at high risk of stroke reported having difficulty performing self-care behavior. Although the literature has identified various factors related to self-care behavior in this population; however, there is a lack of studies to conclude the associated antecedents of self-care behavior, particularly in Thailand.

Objective

This study aimed to examine the relationships between illness perception, functional status, social support, and self-care behavior among people at high risk of stroke.

Methods

A correlational cross-sectional study design was used. One hundred and seventy people at high risk of stroke were selected from ten health-promoting hospitals in the Northeast region of Thailand using multi-stage sampling. Data were gathered using self-report questionnaires, including the brief illness perception questionnaire, functional status scale, multidimensional scale of perceived social support, and self-care behavior questionnaire, from November 2021 to February 2022. Data were analyzed using mean, standard deviation, and Pearson's product-moment correlation.

Results

One hundred percent of the participants completed the questionnaires. The participants had a moderate level of self-care behavior (M = 64.54, SD = 7.46). Social support and functional status had medium positive significant correlations with self-care behavior among people at high risk of stroke (r = 0.460 and r = 0.304, p <0.01), respectively. In contrast, illness perception had a small negative significant correlation with self-care behavior among people at high risk of stroke (r = -0.179, p <0.05).

Conclusion

Social support, functional status, and illness perception are essential factors of self-care behavior among people at high risk of stroke. The findings shed light that nurses and other healthcare professionals should promote self-care behavior in these people by enhancing them to maintain proper functioning, positive illness-related perception, and family members' involvement. However, further study is needed to determine a causal relationship between these factors with self-care behavior.