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

, 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 references 45

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      Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research.

      Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.
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        Urinary sodium and potassium excretion, mortality, and cardiovascular events.

        The optimal range of sodium intake for cardiovascular health is controversial. We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥ 7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome. In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. (Funded by the Population Health Research Institute and others.).
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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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            Author and article information

            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
            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 )
            31060415
            6512114
            10.1161/JAHA.119.012007
            JAH34030
            © 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.

            Counts
            Figures: 5, Tables: 9, Pages: 16, Words: 5260
            Product
            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

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