Twenty‐four–hour urine collection is the recommended method for estimating sodium intake. To investigate the strengths and limitations of methods used to assess completion of 24‐hour urine collection, the authors systematically reviewed the literature on the accuracy and usefulness of methods vs para‐aminobenzoic acid (PABA) recovery (referent). The percentage of incomplete collections, based onPABA, was 6% to 47% (n=8 studies). The sensitivity and specificity for identifying incomplete collection using creatinine criteria (n=4 studies) was 6% to 63% and 57% to 99.7%, respectively. The most sensitive method for removing incomplete collections was a creatinine index <0.7. In pooled analysis (≥2 studies), mean urine creatinine excretion and volume were higher among participants with complete collection (P<.05); whereas, self‐reported collection time did not differ by completion status. Compared with participants with incomplete collection, mean 24‐hour sodium excretion was 19.6 mmol higher (n=1781 specimens, 5 studies) in patients with complete collection. Sodium excretion may be underestimated by inclusion of incomplete 24‐hour urine collections. None of the current approaches reliably assess completion of 24‐hour urine collection.

Over the past decade, blood pressure and sodium intake declined among children and adolescents (ie, youths) in the United States. We updated temporal trends and determined if secular changes in blood pressure might be partly associated with usual sodium intake. We included 12 249 youths aged 8 to 17 years who participated in the National Health and Nutrition Examination Survey from 2003 to 2016 and had blood pressure and dietary data. Logistic regression was used to describe secular trends and the association between usual sodium intake and blood pressure categorized according to 2017 Hypertension Guidelines. The prevalence of youths with combined elevated blood pressure/hypertension (ie, either elevated blood pressure or hypertension) significantly declined from 16.2% in 2003-2004 to 13.3% in 2015-2016 ( P <0.001 for trend), as did hypertension from 6.6% to 4.9% ( P =0.005 for trend). Across the same time period, mean usual sodium intake decreased from 3381 to 3208 mg/day ( P <0.001 for trend). Holding constant survey cycle, sex, age, race and Hispanic origin, and weight status, the adjusted odds ratio per 1000 mg/day of usual sodium intake for elevated blood pressure/hypertension was 1.18 (95% CI, 1.03–1.35) and for hypertension was 1.20 (95% CI, 0.96–1.50). From 2003 to 2016, blood pressure and usual sodium intake declined among youths. Although 1000 mg/day higher usual sodium intake was associated with ≈20% higher odds of elevated blood pressure/hypertension and hypertension, the association with hypertension was not statistically significant.

Objective: The objective of this study was to assess the potential health and budgetary impacts of implementing a pharmacist-involved team-based hypertension management model in the United States. Research Design: In 2017, we evaluated a pharmacist-involved team-based care intervention among 3 targeted groups using a microsimulation model designed to estimate cardiovascular event incidence and associated health care spending in a cross-section of individuals representative of the US population: implementing it among patients with: (1) newly diagnosed hypertension; (2) persistently (≥1 year) uncontrolled blood pressure (BP); or (3) treated, yet persistently uncontrolled BP—and report outcomes over 5 and 20 years. We describe the spending thresholds for each intervention strategy to achieve budget neutrality in 5 years from a payer’s perspective. Results: Offering this intervention could prevent 22.9–36.8 million person-years of uncontrolled BP and 77,200–230,900 heart attacks and strokes in 5 years (83.8–174.8 million and 393,200–922,900 in 20 years, respectively). Health and economic benefits strongly favored groups 2 and 3. Assuming an intervention cost of $525 per enrollee, the intervention generates 5-year budgetary cost-savings only for Medicare among groups 2 and 3. To achieve budget neutrality in 5 years across all groups, intervention costs per person need to be around $35 for Medicaid, $180 for private insurance, and $335 for Medicare enrollees. Conclusions: Adopting a pharmacist-involved team-based hypertension model could substantially improve BP control and cardiovascular outcomes in the United States. Net cost-savings among groups 2 and 3 make a compelling case for Medicare, but favorable economics may also be possible for private insurers, particularly if innovations could moderately lower the cost of delivering an effective intervention.

Background: Concern has been expressed by some that sodium reduction could lead to increased prevalence of hyponatremia and hyperkalemia for specific population subgroups. Current concentrations of serum sodium and potassium in the US population can help address this concern. Methods: We used data from the National Health and Nutrition Examination Survey 2009–2016 to examine mean and selected percentiles of serum sodium and potassium by sex and age group among 25 520 US participants aged 12 years or older. Logistic regression models with predicted residuals were used to examine the age-adjusted prevalence of low serum sodium and high serum potassium among adults aged 20 or older by selected sociodemographic characteristics and by health conditions or medication use. Results: The distributions of serum sodium and potassium concentrations were within normal reference intervals overall and across Dietary Reference Intake life-stage groups, with a few exceptions. Overall, 2% of US adults had low serum sodium (5 mmol/L). Prevalence of low serum sodium and high serum potassium was higher among adults aged 71 or older (4.7 and 2.0%, respectively) and among adults with chronic kidney disease (3.4 and 1.9%), diabetes (5.0 and 1.1%), or using certain medications (which varied by condition), adjusted for age; whereas, prevalence was <1% among adults without these conditions or medications. Conclusions: Most of the US population has normal serum sodium and potassium concentrations; these data describe population subgroups at higher risk of low serum sodium and high serum potassium and can inform clinical care.

As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.