Cardiologists, Public health experts urges managing salt intake to control hypertension

As India observed Salt Awareness Week from 11th to 17th March, leading doctors and public health experts raised alarm regarding excess salt intake and its impact on the rising prevalence of hypertension in the country. High blood pressure is responsible for at least 10.4 million deaths and 218 million disabilities adjusted life years (DALY) globally. In India, untreated and uncontrolled BP, is a leading cause for premature death and disability. Experts call for nationwide prioritization of salt reduction – an easily modifiable risk factor for hypertension that will save millions of Indian lives. It contributes to an estimated 1.6 million deaths annually in India - fifty seven percent of these deaths related to stroke and 24% related to coronary heart disease caused by hypertension.

Dr Chandrakant Pandav, President, Indian Coalition for the Control of Iodine Deficiency Disorders (ICCIDD), warns that the importance of salt in relation to cardio vascular disease and hypertension is a largely ignored issue. Dr Pandav, popularly known as the ‘iodine man’ of the country, said, “By fortifying its salt with iodine, India had taken a gigantic step and saved millions of lives. It is time now to aggressively reduce sodium intake to prevent cardiovascular disease burden. This is a tall task as an average Indian consumes about 10 gms of salt per day, which is double the recommended amount of 5 gms. For a dietary shift of this scale, consumer education will have to be supplemented with regulatory measures such as warning labels, introduction of mandatory thresholds, salt substitutes being made available. This will require a multi stakeholder approach led by government with full cooperation of industry, medical community and the media.”

Salt reduction is one of the 9 NCD targets proposed by WHO to be achieved by 2025. A mid term evaluation conducted by George Institute of Global Health, PAHO, WHO, Resolve to Save Lives and others of the salt reduction target, reveals that globally salt reduction interventions are on the rise. According to the study, countries are beginning to proactively adopt measures such as reformulation of food, front of package warning labels (FOPL), consumer behaviour campaigns, public procurement and salt taxation to reduce salt in people’s diets. Europe leads the way with 75% of its countries in various stages of planning and implementing a national salt reduction initiative. India too has pledged to attain this voluntary target of 30% reduction in salt/sodium intake by 2025. The Food Safety and Standards Authority of India (FSSAI) regularly conducts awareness campaigns such as “Aaj Se Thoda Kam” and the recently concluded “National Low Salt Cooking Challenge” last week as part of the Eat Right India Movement.

Reducing salt intake is considered to be one of the most cost effective measures to lower the risk of blood pressure, heart disease and stroke. According to Dr SS Sodhi, eminent cardiologist and President, Indian Medical Association (IMA), Mohali, “There is enough evidence to show that reduction in salt intake decreases blood pressure and incidence of hypertension. For India, which already has such a high disease burden of cardio vascular disease – of the 17.7 million deaths worldwide, India accounts for at least one fifth – modifying salt intake as a risk factor for hypertension should be a priority. Indians are known to consume more than 100% of the recommended daily limit of salt intake. We need to adopt a two pronged approach – encourage people to eat less salt and at the same time educate them about excess salt as a risk factor for blood pressure.”

Underscoring the importance of consumer awareness, head of Consumer VOICE, India’s leading consumer rights organization, Mr Ashim Sanyal said “Reducing sodium intake would save millions of lives each year. As a consumer organisation we are continually making an effort to educate the consumers and to draw the attention of industry to this important issue. For instance, not many of us are aware that the bread we consume on a daily basis has such high salt content.”

Hypertension, often termed as a silent killer because it can exist without symptoms, has gained prominence recently as a leading Covid-19 comorbidity. More than 1 billion people across the world are living with this condition and there are countless others who remain undiagnosed and untreated. Treatment compliance is extremely poor, leaving a large section of the population vulnerable to sudden cardiac events. Reduction of raised blood pressure and reduced intake of sodium were included as targets in the global NCD action plan in 2011. World over at least 2.5 millions deaths annually are linked to excess salt intake.