kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.3.98 kjhp-15-98 Original Article Anti-Hypertensive Effect of a Solar Salt Diet in Elderly Hypertensive Patients: A Preliminary Randomized, Double-Blind Clinical Trial BaekSeung Ha 1 AhnJu Won 1 LeeHye-Ree 2 ChoSoo Hyun 1 KimJung-Ha 1 Department of Family Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Corresponding author：Jung-Ha Kim, MD, PhD Department of Family Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-1800-1114, Fax: +82-2-6264-8272 E-mail: girlpower219@cau.ac.kr

Financial support was provided by the Ministry of Knowledge and Economy through a regional technology innovation program.

 122015 19122015 153 98106 09032015 07072015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

High sodium and/or low mineral intake are known to be associated with elevated blood pressure. It has been reported that substituting low-sodium, mineral-rich salt for refined salt lowers blood pressure (BP). And solar salt is emerging as a low sodium high mineral salt for a healthy diet in Korea. Therefore, this double-blind, randomized, and placebo-controlled trial was conducted to explore changes in BP from substituting refined salt with solar salt among hypertensive elderly subjects.

 Methods

Forty-three hypertensive and institutionalized elderly individuals aged 65 years or older were enrolled. Thirty-eight subjects (88.4%) completed the study. Subjects were provided with either a solar salt- or refined salt-based diet for eight weeks.

 Results

Systolic BP decreased significantly in the solar salt-based diet group after 2, 4, and 8 weeks when compared to the refined salt-based diet group. And, diastolic BP was lowered significantly in the solar salt-based diet group compared to that in the refined salt-based diet group after 8 weeks. In addition, urinary sodium/po-tassium, and angiotension converting enzyme activity decreased significantly in the solar salt-based diet group compared to the refined salt-based group. Urinary potassium excretion was significantly increased in the solar salt-based diet group.

 Conclusions

These results may provide clinical evidence that solar salt has beneficial effects on BP in elderly patients. And, people such as Koreans, who do not consume enough minerals, may experience a greater anti-hypotensive effect by using solar salt. However, further large-scale studies are necessary.

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Flowchart of the study design and study subjects. BP, blood pressure.

(A) Changes in systolic and diastolic blood pressures with intake of solar or refined salt over eight weeks. P-values were calculated using Wilcoxon rank sum test and Wilcoxon signed rank test. (B) The rate of change in ACE activity with intake of solar (least square mean [SE]: -15.45 [16.13]) or refined salt (least square mean [SE]: 34.09 [14.82]) before and after the study. P-values were calculated using ANCOVA. ACE, angiotensin converting enzyme; SE, standard error.

Clinical characteristics of the subjects at baseline

Solar salt (n=18) Refined salt (n=20) Pa
Age, y 79.5 (75-88)b 80.0 (77-84)b 0.520
Body mass index, kg/m2 24.4 (19.9-25.8)b 23.8 (19.2-25.3)b 0.270
Sex 0.170
Male 9 (64.29)c 5 (25.00)c
Female 9 (36.00)c 15 (75.00)c
Blood pressure, mmHg
Systolic 127.5 (121-140)b 129.0 (122-136)b 0.300
Diastolic 74.0 (70-94)b 76.0 (70-88)b 0.610
Pulse rate, beat/min 75 (70-82)b 72 (69-78)b 0.250
Geriatric functional assessment, score
MMSE-K 21 (13-23)b 20 (12-23)b 0.380
K-ADL 4.0 (2-7)b 4.0 (1-8)b 0.610
S-IADL 29.5 (20.0-38)b 32 (30-38)b 0.470
GDS 4.0 (3-5)b 5.0 (4-5)b 0.440
Antihypertensive medication 13 (72.2)c 14 (66.6)c 0.980
Diuretics 2 (15.38)c 1 (7.14)c
Calcium channel blockers 12 (92.31)c 13 (92.86)c
ACE inhibitors or ARBs 8 (61.54)c 6 (42.86)c
Beta-blockers 2 (15.38)c 3 (21.43)c
Medical history
Cardiovascular diseased 8 (44.44)c 9 (42.86)c 0.990
Diabetes mellitus 8 (44.44)c 6 (28.57)c 0.760
Dyslipidemia 2 (11.11)c 1 (4.76)c 0.590
Dementia 6 (33.33)c 7 (33.33)c 1.000
Osteoporosis 3 (16.67)c 7 (33.33)c 0.290

Abbreviations: MMSE-K, mini-mental state examination-Korean version; K-ADL, Korean activities of daily living; S-IADL, Seoul- instrumental activities of daily living; GDS, global deterioration scale; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

Calculated using a Wilcoxon rank sum test, Fisher’s exact test or χ

-test.

Median (25-75%).

Number (%).

Cerebral infarction, cerebral hemorrhage, myocardial infarction, angina or atherosclerosis.

Changes in nutrient intake by the w weighing method after 8 weeks

Solar salt (n=18) Pa Refined salt (n=20) Pa
Pre (baseline) Post (8 wk) Pre (baseline) Post (8 wk)
Calorie intake, kcal 1,299.06 1,324.52 0.770 1,271.91 1,355.25 0.120
(1,142.71-1,729.12)b (1,011.63-1,732.43)b (1,044.55-1,503.03)b (1,178.77-1,475.32)b
Protein, % energy 16.61 (15.27-18.87)b 16.48 (14.53-17.78)b 0.770 17.94 (16.24-19.70)b 17.01 (16.15-17.62)b 0.160
Fat, % energy 19.92 (15.20-22.37)b 20.87 (14.97-23.08)b 0.090 20.60 (19.41-23.85)b 22.00 (18.87-23.03)b 0.930
Carbohydrate, % energ gy 63.14 (58.72-69.44)b 62.65 (58.81-70.36)b 0.640 62.30 (55.77-63.82)b 60.97 (58.90-64.98)b 0.650

Calculated using a Wilcoxon signed rank test.

Median (25-75%).

Changes in study outcomes of solar- or refined salt-based diet after 8 weeksa

Solar salt (n=18) Refined salt (n=20)
Pre (baseline) Post (8 wk) Pb Pre (baseline) Post (8 wk) Pb
Body mass index 24.4 (19.9-25.8) 24.8 (19.8-26.0) 0.820 23.8 (19.2-25.3) 23.9 (19.5-25.8) 0.750
Blood pressure, mmHg
Systolicc 127.5 (121-140) 110 (102-120) 0.007 129.0 (122-136) 128.5 (120-136) 0.930
Diastolic 74.0 (70-94) 69.0 (66-74) 0.090 76.0 (70-88) 78 (72-88) 0.930
Pulse rate, beat/min 75 (70-82) 77 (70-82) 0.720 72 (69-78) 72 (69-76) 0.830
Antihypertensive medication 13 (72.2) 10 (55.6) 0.300 14 (70.0) 15 (75.0) 0.730
Glucose tolerance index
Fasting glucose, mg/dL 95.0 (90-110) 93.5 (86.0-131.0) 0.770 90.5 (83.0-97.5) 90.0 (82.0-100.0) 0.410
Fasting insulin, μIU/mL 9.24 (6.22-12.79) 8.18 (6.54-11.72) 0.310 9.20 (6.77-12.24) 9.40 (6.74-11.74) 0.900
HOMA-IR Lipid profile 2.30 (1.35-3.32) 2.33 (1.43-3.93) 0.280 2.25 (1.79-3.04) 2.27 (1.82-3.42) 0.900
Total cholesterol, mg/dL 184 (156-221) 166 (132-201) 0.080 169 (158.5-201.5) 164 (143-194) 0.620
Triglyceride, mg/dL 142.5 (11.20-220.0) 141 (105-270) 0.920 135.5 (101.5-157.5) 116 (101-156) 0.230
HDL-cholesterol, mg/dL 34.6 (32.0-43.1) 36.55 (32.60-43.75) 0.670 33.45 (30.60-45.70) 34.0 (32.0-46.3) 0.170
Renal function test
Blood urea nitrogen, mg/dL 14.5 (10.3-16.2) 12.85 (11.00-15.25) 0.920 13.45 (10.10-18.40) 12.47 (10.90-15.80) 0.860
Creatinine, mg/dL Electrolyte 0.9 (0.8-1.3) 0.8 (0.7-1.25) 0.530 0.9 (0.8-1.0) 0.9 (0.8-1.0) 0.780
Serum sodium, mEq/L 138 (138-140) 138.5 (136.0-142) 0.530 137.5 (136.0-140) 140 (136-142) 0.110
Serum potassium, mEq/L 4.2 (4.0-4.5) 4.45 (3.80-4.60) 0.030 4.00 (3.80-4.35) 4.05 (3.80-4.20) 0.320
Urinary sodium, mEq/L 80 (57-109) 94 (46-121) 0.890 88 (54-118) 86.5 (49.0-120) 0.460
Urinary potassiumc, mEq/L 30 (24-32.5) 36.5 (30.5-49) 0.008 25.5 (17-38) 23.5 (14.5-36.5) 0.340
Urinary sodium/potassiumc 2.34 (1.97-3.64) 2.07 (1.25-3.21) 0.040 2.67 (2.20-4.59) 3.44 (2.47-4.39) 0.520

Abbreviations: HOMA-IR, homeostasis model assessment of insulin resistance; HDL, high density lipoprotein.

Values are presented as median (25-75%) or N (%).

Calculated using a Wilcoxon signed rank test or χ

-test within each group.

Statistical significance at P<0.05 according to a Wilcoxon rank sum test for comparing % change between two groups.