Every day I see patients in the Intensive Care Unit suffering from the consequences of high blood pressure. Coronary artery disease and stroke continue to contribute significantly to the population’s morbidity and mortality in the United States. Billions of dollars are spent each year acute and long-term care for these patients. One of the biggest risk factors for both conditions is hypertension or high blood pressure.

Hypertension is extremely common in the general population. Dietary indiscretions, including high salt intake, contribute to the development of hypertension. The maximum recommended sodium intake is about 2300mg/day. Yet, it is estimated that an average adult in the US consumes almost 4000mg/day.

It has been proven by multiple studies that diminished salt intake can lead to better blood pressure, decreasing the risk for both heart disease and stroke. It was also shown that it is possible to modify salt intake of the entire country’s population by reducing the sodium targets for specific food. The success of recent efforts in the United Kingdom to work with the food manufactures that lead to 9.5% decrease in nation’s sodium intake has sparked interest in population based strategies that can reduce the risk of heart disease and stroke.

A study published in the Annals of Internal Medicine examines two strategies for the reduction of sodium intake in the United States. The two strategies include reducing sodium targets for processed food and the implementation of a tax on sodium used for food production.

The authors assumed that based on the United Kingdom experience, it is possible to reduce the population's sodium intake by 9.5% by modifying salt content in processed food. The tax strategy assumes that a price increase of 40% on high sodium food would result in 6.0% reduction in sodium intake.

The conclusions of this study are quite impressive. It was estimated that a 9.5% reduction in sodium intake would result in only a 1.25mm Hg decrease in mean systolic blood pressure (for persons aged 40 to 85 years alive today in the US), yet it would prevent 513, 885 strokes and 480,358 MIs (myocardial infarction) The estimated savings of $32.1 billion in direct medical cost were also predicted from this strategy.

The tax strategy was less effective. A 6% decrease in sodium intake would result in a 0.93 mm Hg average blood pressure reduction preventing 327,892 strokes and 306,137 MIs. It would still save close to 22 billions over the lifetime of adults aged 40 to 85 years alive today.

The authors recognize the potential pitfalls of the population based strategies. For example, decreased sodium in processed food may lead to a compensatory increase in intake of sugar and fat rich food. The study is based on predictions from a mathematical model and those predictions might not quite work out in real life.

At the same time, the benefits of a reduced salt intake go beyond heart disease and stroke. Lower blood pressure will prevent many cases of end-stage renal disease and hypertensive (non-ischemic) heart failure, saving us many more billions of dollars.

In conclusion, it is a personal responsibility to maintain one’s health. Yet on a population-based level, effective strategies are available to control and prevent the spread of many diseases. And if this also prevents Medicare and Social Security from going broke, it is a welcome initiative.