Sodium In takev anrd Heart Failure,(low sodium In ḥṭake,)

 3. Low Sodium Intake and Prevention or Management of HF

3.1. Evidence in Favor of Low Sodium Intake in Prevention or Management of HF

Systemic hypertension is one of the main risk factors for the development of HF. The lifetime risk of HF decreases with adequate treatment of blood pressure. Data from meta-analysis suggest a dose–response relationship between salt intake and increased blood pressure [12]. In a pooled analysis from four large prospective studies involving 133,118 patients, higher sodium intake was associated with increased risk of cardiovascular events and death compared with moderate sodium intake in hypertensive populations over a median of 4.2 years [13]. Systemic hypertension, if untreated, is a major risk factor for development of left ventricular hypertrophy. In the hypertensive patient population, diastolic dysfunction, left ventricular hypertrophy, and arterial stiffness are associated with urinary sodium excretion, and limiting sodium intake is associated with regression of left ventricular hypertrophy [14,15,16,17]. The proposed mechanism of regression of left ventricular hypertrophy with sodium restriction is improved large-arterial stiffness and microvascular endothelial dysfunction [18,19]. Sodium restriction is appropriate in patients with stage A (at risk for HF) and B (asymptomatic) HF due to its effect on lowering blood pressure, the incidence of hypertension, left ventricular hypertrophy, cardiovascular disease, and even incidence of HF [17,20,21,22,23,24]. However, there is insufficient evidence for such recommendation for stage C (with prior or current symptoms) and D (refractory) HF [25]. The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes limiting sodium intake, has been shown to be associated with a lower incidence of HF in a prospective observational study of 36,019 participants in the Swedish Mammography Cohort over a course of seven years [26].