INTRODUCTION:

Excessive
consumption of salt is believed to have a link to causing hypertension for
decades. Is this just a belief or is there any scientific evidence to verify
this. Salt restriction advice and dietary intake target of <6g per day is recommended to patients, especially to hypertensive patients by clinicians and health organisations. Salt is naturally formed, it can be found under the ground, on earth's surface and it has been around since the time of human ancestors. It is consumed in the form of NaCl and is an essential electrolyte and mineral that plays an important role in human body.  it is also used worldwide for flavouring, preserving food, tanning, bleaching and In chemical industry etc. According to the world sodium chloride pie chart, salt consumption is high in  China, North America and Western Europe. China is currently the largest salt producer in the world followed closely by the United States and is generally produced through deep-shaft mining, solution mining or solar evaporation. According to National Center for Biotechnology Information, U.S. National Library of Medicine; For several million years, our ancestors consumed a diet that contained less than 1g of salt per day, with its intake reaching its peak around the 19th century. But with the invention of refrigerator, salt was no longer required as a food preservative. This then eventually declined the level of salt intake but recently there is a large increase in the consumption of highly salted processed food, salt intake is increasing towards the level of 19th century which was once at its peak and approximately 9-12g salt per day is consumed around the world. Sodium and chloride helps to regulate blood pressure, maintain intracellular and extracellular fluid balance, absorption of nutrients, maintenance of cognitive function, nerve impulse transmission, muscle contraction etc. Balance between sodium intake, water intake and water excretion plays an important role in the maintenance of regulating arterial pressure. Normal balance of sodium leads to a stable body fluid volume and the maintenance of normal renal function is critical to establishing extracellular fluid volume homeostasis. The kidney filters the blood and removes unwanted fluids and waste materials from the body through the process of osmosis. To do this a delicate balance between sodium and potassium is required. High salt intake raises the amount of sodium in the bloodstream, disrupting the sodium - potassium balance and reducing the ability of kidney to function properly, which causes fluid retention and raises the blood pressure. cardiovascular system is one of the main organ systems affected by the adverse effects of excessive sodium intake, causing development of cardiovascular diseases and it accounts for 60% of all strokes and 50% of all heart diseases.  A blood pressure of 140/90 mmHg or higher is defined as hypertension.  Risk of hypertension increases throughout the range of systolic blood pressure starting from 115mmHg. High blood pressure is the  modifiable risk factor for cardiovascular disease. According to a health article published by Dailymail, Hypertension is the most prevalent chronic disease across the world. Known as a 'silent killer' as it shows no obvious symptoms. "Hypertension is the leading preventable risk factor for premature death and disability worldwide. Previous work estimated that 26.4% of the global adult population, or 972 million people, had hypertension in 2000" states American heart association.                         The report cites that hypertension rates very high in Western Europe than in the United States; 38% in England, Sweden and Italy; 45% in Spain and 55% in Germany in the highest. According to The National Nutrition Survey II, processed foods, in particular bread, meat, sausages and cheese, make the largest contribution to salt intake in Germany. Modifiable risk Factors of hypertension includes lack of physical activity, an unhealthy diet, especially high in sodium, being overweight or obese, too much alcohol, sleep apnea, high cholesterol, diabetes, smoking, tobacco use and stress. 1st article : "low-sodium diet might not lower blood pressure" This article consists a large 16 year long study based in America that is carried out using more than 2,600 men and women ages 30 to 64 years who consumed less than 2,500mg of sodium a day. 2015-2020 Dietry Guidelines for Americans recommends a sodium intake of 2,300mg (2.3g) per day for healthy people. After carrying out this study researchers concluded that "we saw no evidence that a diet lower in sodium had any long term beneficial effects on blood pressure" and that people with low sodium diet ( as recommended by the dietry guideline) and high sodium diet (above the average intake) had higher risk of heart disease compared to those people who consumed a medium sodium diet. The researchers also found that those who had a higher dietry intake of potassium, calcium and magnesium had the lowest blood pressure over the long term and had brought forth the importance of higher potassium intake, especially in cardiovascular conditions. 2nd  article: "National Diet and Nutrition Survey - Assessment of dietary sodium in adults (aged 19 to 64 years) in England, 2011" This article is based on a survey conducted to provide sufficient data to establish progress towards the Department of Health's target to reduce average dietary intake of population to less than 6g per day. Survey was conducted on 600 participants aged 19-64 living in England. A 24 hour urine samples was collected from the participants and urinary sodium excretion was carried out to estimate salt intake. The mean estimated salt intake was 8.1g per day in both men and women, with men having a mean estimated intake of 9.3g per day and women 6.8g. 80% men population and 58% women have exceeded the maximum salt intake recommendation of 6g per day. Furthermore, after analysing previous surveys carried out in the UK, statistics have shown that there has been a reduction in mean estimated salt intake between 2000 and 2011. 3rd Article: Salt intake belief, knowledge, and behaviour; a cross-sectional study of rural Chinese adults. This article is based on a study conducted in rural areas of northern China. The study took part in 2010 September with the participation of 5050 older adults from 120 villages. The aim of the study was to assess the relationship between salt intake behaviours, perception of the harm of high salt intake and knowledge about salt and health among older adults. Participants were surveyed about their belief of high salt intake effect on health. About 60% of the participants believed high salt intake would harm their health. The belief was negatively associated with age, positively with years of school and was high in women than men. Within the 60% of participants who believed that high salt intake is harmful to health, only 30% knew the fact that less intake can lower blood pressure. To conclude, this study shows that healthy salt intake behaviour was associated with simple belief rather than the knowledge. To summarise, after a 16 year long study article 1 states that salt might not be the main cause of hypertension and has brought forth the recommendation to increase potassium, calcium and magnesium intake with the thought of reducing blood pressure. Article 2 portraits that "scientific evidence suggests that a high salt intake contributes to the development of high blood pressure" and the Department of Health recommended restriction on dietary intake of salt. Since first survey carried out in 2000 a reduction has been estimated in the percentage of salt intake in men and women. Article 3 brought forward the thought that salt reduction behaviour in Chinese population was based on their belief rather than actual knowledge regarding health. This project aims to prove the belief of "salt leads to high blood pressure" and conduct a salt reduction program to emphasize the seriousness of high sodium intake and how it leads to many underlying conditions of cardiovascular system and renal system; and how it can be prevented in younger generations. Objective: ·         To investigate whether salt restriction has helped to lower blood pressure. ·         To explore the knowledge about salt being a risk factor of high blood pressure in the younger generations. And if they have ever considered a low salt diet. ·         To raise awareness worldwide and bring down the percentage of cardiovascular diseases. ·         To educate people and provide knowledge about risk factors of hypertension. Study question:  To raise awareness of risk factors of high salt intake. Design: This project incorporates both qualitative and quantitative methods of research. Methodology: The first objective of this project is to investigate if salt restriction recommendation given to long term hypertensive patients has helped them bring down their blood pressure. This study will be conducted through a questionnaire asking that asks the participants about their daily salt consumption, how they made a change to their intake, their management and if they have seen any productive results. This task will be carried out through the aid of local GP, pharmacy and getting in contact with their long term hypertensive patients through phone or house visit after getting their permission. Possibly a group session with the presence of health care professionals and patients will be conducted to discuss the modifiable risk factors of hypertension. The second objective of this project to explore the younger generations' knowledge regarding the risk of high salt consumption and this will be carried out using university students. A study will be conducted between medical and non-medical students  in the form of questionnaires or short interviews. This is in order to see if their scientific knowledge made them aware of the risk. Third objective will be met by collaborating with British Heart Foundation and other worldwide heart charities to reach higher. High salt intake's risk factors are well known in hypertensive patients, this fourth objective aims to reach out to un-hypertensive patients through advertisements and posters. Advertising in health websites and posting related poster on hospitals, wards, pharmacies and GPs. Ethics: I will make sure to keep the participants personal details such as contact information, address, names, medical conditions private and confidential. I will be requesting ethics from academic board and university ethics committee as I will be involved with university students and lecturers. Both my questionnaires and interview will include informed consent.        Selection Criteria: Inclusion Criteria:  hypertensive patients, non-hypertensive patients, travellers, tourists, public both male and female aged 18 and above. Exclusion Criteria: aged 17 and under. Material and budget: Required resource Estimated cost Computer access, including advertisement  and poster making, printing and copying.  £400 Transportation £200 Questionnaires and personnel's (including health professionals) £500 Venue hiring  £100 - £200 Charity donation  £200 Phone access   £100   Timeline: Qualitative research part of this project aims to complete over the period of 2 years; with reaching out to public and raising awareness of high salt intake will continue. Disease caused by hypertension costs NHS over £2 billion a year.  So undertaking this project and carrying out its research will benefit the current body of knowledge. It aims to raise awareness to the pubic and modify the risk factor that contributes as the cause of hypertension.      

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