Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. In 2019, 1.72 million deaths and 40.54 million DALYs were caused by CVD due to high dietary sodium globally, representing a 41.08% and 33.06% increase since 1990. In 2023, this estimate further increased to 1.89 million deaths associated with excess sodium consumption. Both India and the United States of America top the list of most burdened countries.
This data is alarming considering the cause has been well known for decades and can be relatively easily addressed. These studies do not call for complex medication regimens or treatments. The totality of the evidence strongly supports a population-wide reduction in salt intake (AHA). Salt reduction causes a dose-dependent reduction in blood pressure: the lower the salt intake, the lower the blood pressure (AHA).
Yet, medical organizations and governments are barely engaged in salt reduction to prevent hypertension. It is reflected in WHO’s cry for help: “massive efforts needed to reduce salt intake and protect lives”. Only nine countries (Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain and Uruguay) have a comprehensive package of
recommended policies to reduce sodium intake. WHO again says: “Reducing sodium intake is one of the most cost-effective measures to improve health and reduce the burden of
non-communicable diseases: for every US $1 invested in scaling up sodium reduction interventions, there will be a return of at least US$12.”
In India, of the estimated 220 million people with hypertension, only 12% have their blood pressure under control. Hypertension kills more adults than any other cause and is readily preventable and treatable. The India Hypertension Control Initiative (IHCI) is principally
engaged in improving better diagnosis and treatment of hypertension.
But what about prevention? It’s time to look at high blood pressure as a preventable disease. India only received a score of 2 (out of 4) from WHO due to its lack of mandatory sodium declaration policy. WHO estimates that 7 million lives could be saved worldwide by 2030 if countries can adopt appropriate sodium reduction, however few countries are on track. To achieve this goal WHO recommends mandatory legislation that includes maximum sodium content limit, marketing restrictions, labelling and fiscal policies.
Global health care agencies must prioritize salt reduction as the critical strategy for the prevention of cardiovascular disease globally. Adding salt to food confers no known nutritional benefit, while increasing the risk of hypertension and many other deadly or disabling diseases. It’s time to tackle the root cause.
