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      Drinking Water Salinity, Urinary Macro‐Mineral Excretions, and Blood Pressure in the Southwest Coastal Population of Bangladesh

      research-article
      , MBBS, PhD 1 , 2 , , , MPH 3 , , PhD 3 , , MPH 3 , , MS 3 , , MS 3 , , MS 3 , , MS 3 , , MS 3 , , PhD 4 , , PhD 5 , , MD 6 , , MD 1 , , PhD 7 , , MD 8 ,   , PhD, DABT 2 , 9 , , PhD 2
      Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
      John Wiley and Sons Inc.
      blood pressure, calcium, drinking water salinity, magnesium, potassium, sodium, water salinity, Epidemiology, Diet and Nutrition, Hypertension

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          Abstract

          Background

          Sodium (Na +) in saline water may increase blood pressure ( BP), but potassium (K +), calcium (Ca 2+), and magnesium (Mg 2+) may lower BP. We assessed the association between drinking water salinity and population BP.

          Methods and Results

          We pooled 6487 BP measurements from 2 cohorts in coastal Bangladesh. We used multilevel linear models to estimate BP differences across water salinity categories: fresh water (electrical conductivity, <0.7 mS/cm), mild salinity (electrical conductivity ≥0.7 and <2 mS/cm), and moderate salinity (electrical conductivity ≥2 and <10 mS/cm). We assessed whether salinity categories were associated with hypertension using multilevel multinomial logistic models. Models included participant‐, household‐, and community‐level random intercepts. Models were adjusted for age, sex, body mass index ( BMI), physical activity, smoking, household wealth, alcohol consumption, sleep hours, religion, and salt consumption. We evaluated the 24‐hour urinary minerals across salinity categories, and the associations between urinary minerals and BP using multilevel linear models. Compared with fresh water drinkers, mild‐salinity water drinkers had lower mean systolic BP (−1.55 [95% CI: −3.22–0.12] mm Hg) and lower mean diastolic BP (−1.26 [95% CI: −2.21–−0.32] mm Hg) adjusted models. The adjusted odds ratio among mild‐salinity water drinkers for stage 1 hypertension was 0.60 (95% CI: 0.43–0.84) and for stage 2 hypertension was 0.56 (95% CI: 0.46–0.89). Mild‐salinity water drinkers had high urinary Ca 2+, and Mg 2+, and both urinary Ca 2+ and Mg 2+ were associated with lower BP.

          Conclusions

          Drinking mild‐salinity water was associated with lower BP, which can be explained by higher intake of Ca 2+ and Mg 2+ through saline water.

          Abstract

          See Editorial Bispham and Nowak

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          Most cited references37

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          2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

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            Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials.

            To assess the effects of supplementation with oral potassium on blood pressure in humans. Meta-analysis of randomized controlled trials. English-language articles published before July 1995. Thirty-three randomized controlled trials (2609 participants) in which potassium supplementation was the only difference between the intervention and control conditions. Using a standardized protocol, 2 of us independently abstracted information on sample size, duration, study design, potassium dose, participant characteristics, and treatment results. By means of a random-effects model, findings from individual trials were pooled, after results for each trial were weighted by the inverse of its variance. An extreme effect of potassium in lowering blood pressure was noted in 1 trial. After exclusion of this trial, potassium supplementation was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic blood pressure of -3.11 mm Hg (-1.91 to -4.31 mm Hg) and -1.97 mm Hg (-0.52 to -3.42 mm Hg), respectively. Effects of treatment appeared to be enhanced in studies in which participants were concurrently exposed to a high intake of sodium. Our results support the premise that low potassium intake may play an important role in the genesis of high blood pressure. Increased potassium intake should be considered as a recommendation for prevention and treatment of hypertension, especially in those who are unable to reduce their intake of sodium.
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              Effects of Oral Potassium on Blood Pressure

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                Author and article information

                Contributors
                atitu@emory.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                07 May 2019
                07 May 2019
                : 8
                : 9 ( doiID: 10.1002/jah3.2019.8.issue-9 )
                : e012007
                Affiliations
                [ 1 ] Emory Global Diabetes Research Center Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA
                [ 2 ] Department of Environmental Health Sciences Rollins School of Public Health Emory University Atlanta GA
                [ 3 ] International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Bangladesh
                [ 4 ] Department of Geology University of Dhaka Bangladesh
                [ 5 ] Institute for Risk and Disaster Reduction University College London London United Kingdom
                [ 6 ] Division of Nephrology School of Medicine Stanford University Stanford CA
                [ 7 ] Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
                [ 8 ] Woods Institute for the Environment Stanford University Stanford CA
                [ 9 ] Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
                Author notes
                [*] [* ] Correspondence to: Abu Mohd Naser, MBBS, PhD, Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, CNR 7040‐G, Atlanta, GA 30322. E‐mail: atitu@ 123456emory.edu
                Article
                JAH34030
                10.1161/JAHA.119.012007
                6512114
                31060415
                0cd104fb-8362-434c-88c9-a90d9e3bfdce
                © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 January 2019
                : 21 March 2019
                Page count
                Figures: 5, Tables: 9, Pages: 16, Words: 5260
                Funding
                Funded by: Wellcome Trust
                Award ID: 106871/Z/15/Z
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                jah34030
                07 May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:08.05.2019

                Cardiovascular Medicine
                blood pressure,calcium,drinking water salinity,magnesium,potassium,sodium,water salinity,epidemiology,diet and nutrition,hypertension

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