Staat zoutbeperking nu ter discussie?

A recent meta-analysis published in The Lancet related sodium excretion to mortality in both hypertensive and normotensive subjects. High salt excretion, measured in a spot urine test, was related to increased mortality in hypertensive subjects only, whereas low sodium excretion was related to increased mortality in both hypertensive and normotensive subjects. Here we discuss practical consequences of this analysis. The data underline the importance of salt restriction in hypertension; the analysis also shows that there is a lower limit to salt restriction. Since salt intake cannot be assessed adequately from the sodium content of a single urine sample, 24-hour urine collection is advised in subjects on a salt-restricted diet. A 24-hour urine collection allows checking for unnecessarily strict salt restriction or, as will more often be the case, shows the patient that adequate salt restriction has not yet been attained.

In een recente meta-analyse werd de volgende vraag onderzocht: verschilt de relatie tussen zoutinname en bloeddruk en het risico op cardiovasculaire ziekte en sterfte tussen mensen met en zonder hypertensie?1 De publicatie van de resultaten leidde tot gevarieerde koppen in de internationale media: ‘Te weinig zout verhoogt kans op hart- en vaatziekten’, ‘Take low-salt advice with a grain of you know what’, ‘Global study finds “Salt in moderation” is key to health’, ‘Salt restriction only beneficial in hypertension?’ en ‘Urinary sodium excretion study attracts controversy’.2

Een studie die resulteert in zo veel discussie in de media verdient nadere beschouwing. De belangrijkste conclusie is dat zoutbeperking zinvol is bij patiënten met hypertensie en dat de therapeutische breedte van zoutbeperking niet onbeperkt is. Maar wat zijn de consequenties hiervan voor de Nederlandse praktijk?