Hypertension, Salt, and Bread

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To the Editor:

Hypertension is the major risk factor for development and progression in patients with chronic kidney disease (CKD) and has become the most important intervention in the management of all forms of CKD.¹ The message of World Kidney Day 2009 is “Keep the pressure down.” Similarly, the theme for World Hypertension Day 2009 is “Salt and high blood pressure: two silent killers.” Reduction in dietary salt intake is one of the effective measures to prevent hypertension.²

Average salt intake is 9 to 12 g/d in the Western world; however, the daily recommended amount is no more than 6 g.² The Relationship between Hypertension and Salt Intake in Turkish Population Study (SALTURK) showed that daily salt intake was about 18 g/person in Turkey.³ Bread is one of the major sources of calories/energy in Turkey, and average bread consumption is about 400 g/d/person. Based on these data, we suspected that bread may be a major source of salt intake in Turkey and therefore investigated the salt content of breads by using the titrimetric method.

Results, as well as an estimate of daily salt intake from bread in the Turkish diet, are listed in Table 1. The estimated intake (7.28 g/d) is more than the upper limit of daily recommended amount. We suggest that local patient education programs focused on specific foods (such as the case of bread in Turkey) will decrease salt intake and be useful in the global prevention and treatment of hypertension, CKD, and related problems.

Table 1. Salt Content of Turkish Breads and Estimated Daily Salt Intake From Bread

Sodium chloride (g/100 g bread)
Mean ± SD	1.82 ± 0.41
25th percentile	1.58
50th percentile	1.76
75th percentile	2.05
Estimated daily intake from bread (g)⁎	7.28

Note: One hundred breads were studied from the 7 regions and 46 provinces of Turkey. The distribution of bread samples across regions and provinces was parallel to the populations of these regions and provinces.

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Acknowledgements 

We thank Hasan Yetim and Safa Karaman (Erciyes University) for performing salt content measurements.

Support: The study was supported by the Turkish Society of Nephrology, Kayseri Branch.

Financial Disclosure: None.

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References 

1. Bakris GL, Ritz E. World Kidney Day 2009: Hypertension and kidney disease is a marriage that should be prevented. Am J Kidney Dis. 2009;53:373–376
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2. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252
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3. Erdem Y, Arici M, Altun B, et al. The SALTURK (The Relationship between Hypertension and Salt Intake in Turkish Population) study. http://www.turkhipertansiyon.org/UserFiles/File/salt.pdfAccessed February 1, 2009
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