Author Affiliations: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (Drs O’Donnell and Yusuf) (firstname.lastname@example.org); and Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany (Dr Schmieder).
In Reply: We disagree with Dr Mann that findings from our study run “counter to the consistent evidence that, in individuals with hypertension, decreased sodium intake reduces blood pressure.” We did report a linear association between increased sodium excretion and increased blood pressure, consistent with several other studies.1 Our study is the largest one examining the relationship between measures of urinary sodium excretion (a proxy for intake) in patients at high cardiovascular risk and, consistent with several previous studies, we found an increased risk of cardiovascular events in those with high sodium excretion (>7 g/d), which supports the potential benefit of salt reduction in those with high salt intakes. However, a sodium excretion of less than 3 g/d also was associated with an increased risk of cardiovascular events.
O’Donnell MJ, Schmieder RE, Yusuf S. Urinary Sodium Excretion and Cardiovascular Events—Reply. JAMA. 2012;307(11):1138-1139. doi:10.1001/jama.2012.327