Skip to main content
Article thumbnail
Location of Repository

A community programme to reduce salt intake and blood pressure in Ghana \ud

By Francesco Cappuccio, Sally M. Kerry, Frank B. Micah, Jacob Plange-Rhule and John B. Eastwood


Background\ud In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible.\ud Methods\ud We carried out a community-based cluster randomised trial of health promotion in 1,013 participants from 12 villages (628 women, 481 rural dwellers); mean age 55 years to reduce salt intake and BP. Average BP was 125/74 mmHg and urinary sodium (UNa) 101 mmol/day. A health promotion intervention was provided over 6 months to all villages. Assessments were made at 3 and 6 months. Primary end-points were urinary sodium excretion and BP levels.\ud Results\ud There was a significant positive relationship between salt intake and both systolic (2.17 mmHg [95% CI 0.44 to 3.91] per 50 mmol of UNa per day, p < 0.001) and diastolic BP (1.10 mmHg [0.08 to 1.94], p < 0.001) at baseline. At six months the intervention group showed a reduction in systolic (2.54 mmHg [-1.45 to 6.54]) and diastolic (3.95 mmHg [0.78 to 7.11], p = 0.015) BP when compared to control. There was no significant change in UNa. Smaller villages showed greater reductions in UNa than larger villages (p = 0.042). Irrespective of randomisation, there was a consistent and significant relationship between change in UNa and change in systolic BP, when adjusted for confounders. A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg (1.03 to 3.21) at 3 months and 1.34 mmHg (0.08 to 2.60) at 6 months (both p < 0.001).\ud Conclusion\ud In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP.\u

Topics: R1, RA0421
Publisher: BioMed Central Ltd
Year: 2006
OAI identifier:

Suggested articles


  1. (2001). AD: Healthy life expectancy in 191 countries. Lancet doi
  2. (2000). Alberti KGMM: Stroke mortality in urban and rural Tanzania. Lancet doi
  3. (1994). Amuah EA, Biritwum RB: Current trends in the incidence of cerebrovascular accidents in Accra. West Afr Med J
  4. (2004). Appel LJ: A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. doi
  5. (2004). CJ: Distribution of Major Health Risks: Findings from the Global Burden of Disease Study. Plos Med doi
  6. (2001). Davey-Smith G: Exporting failure? Coronary heart disease and stroke in developing countries. doi
  7. (2003). DB: Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet doi
  8. (1998). Disease burden in sub-Saharan Africa: what should we conclude in the absence of data? Lancet doi
  9. (2005). EJ: Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA doi
  10. (2001). for the DASH-Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. doi
  11. (1989). G: Salt and blood pressure: a community trial. J Hum Hypert
  12. (2002). GA: Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypert doi
  13. (2003). GA: How far should salt intake be reduced? Hypertension doi
  14. (2005). Global burden of hypertension: analysis of worldwide data. Lancet doi
  15. (1998). HV: Effect of variation in environmental temperature on blood pressure: is it important? Central Afr J Med
  16. (2003). Hypertension in Ghana: a cross-sectional community prevalence study in Greater Accra. Ethn Dis
  17. (1998). Hypertension treatment and control in sub-Saharan Africa: the epidemiological basis for policy. Br Med J doi
  18. (2002). JB: A community study of health promotion in rural West Africa: details of a household survey and population census. doi
  19. JB: Prevalence, detection, management and control of hypertension in Ashanti, West Africa. Hypertension doi
  20. (2000). JB: Prevention of hypertension and stroke in Africa. Lancet doi
  21. (2005). JB: Reducing selection bias in a cluster randomised trial in West African villages. Clinical Trials doi
  22. (2000). Klag MJ: Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension doi
  23. (1989). Kofi AD: Hypertension, cerebral vascular changes and stroke in Ghana: cerebral atherosclerosis and stroke. doi
  24. (1997). Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet doi
  25. (2001). Nissinen A: Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet doi
  26. Nyame PK: Stroke-related mortality at Korle Bu Teaching Hospital, doi
  27. (2002). Organization: The World Health Report doi
  28. (1999). PK: Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA doi
  29. Report of a WHO/FAO Expert Consultation: Diet, nutrition and the prevention of chronic diseases. Volume 916. Geneva, World Health Organization. doi
  30. (2005). RS: A randomized trial on sodium reduction in two developing countries. J Hum Hypert doi
  31. (2002). RS: The feasibility of implementing a dietary sodium reduction intervention among free-living normotensive individuals in south West Nigeria. Ethn Dis
  32. (1999). Saggar-Malik AK, Cappuccio FP, Eastwood JB: Hypertension and renal failure in Kumasi, doi
  33. (1993). Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. doi
  34. (2004). Sodium intake and risk of death from stroke in Japanese men and women. Stroke doi
  35. (2005). Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II. J Hum Hypertens doi
  36. (1998). Stroke in the developing world. Lancet doi
  37. (2004). T: Complex interventions: how &quot;out of control&quot; can a randomised controlled trial be? Br Med J doi
  38. (1997). The prevalence of hypertension in seven populations of West African origin. doi
  39. (2004). The SASPI Project Team: Prevalence of stroke survivors in rural South Africa. Stroke doi
  40. (1998). There are no shortcuts to finding out what works – population laboratories are essential tools. Tropical Medicine and International Health doi
  41. (2004). Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.