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Purpose <p>The 2017 ACC/AHA hypertension guidelines lowered the diagnostic threshold to ≥ 130/80 mmHg, substantially increasing adults classified as hypertensive and emphasizing lifestyle modification, including sodium reduction as first-line management. However, whether this reclassification was associated with lower dietary sodium intake at the population level remains unclear.</p> Methods <p>We analyzed NHANES 2013–2023 data, classifying adults by blood pressure category under old (≥ 140/90 mmHg) and new (≥ 130/80 mmHg) hypertension definitions, applied retrospectively to 2013–2016 and to 2017–2023. Sodium intake was assessed via two 24-hour dietary recalls and compared across hypertension categories and diagnosis status using survey-weighted linear regression.</p> Results <p>Mean sodium intake exceeded 3,200&#xa0;mg/day across all periods and blood pressure categories, approximately 40% above the maximum recommended levels of 2300mg/day. Adults consuming ≥ 2,300&#xa0;mg/day declined modestly from 73.6% pre-2017 to 68.7% post-2017. After adjustment, no statistically significant differences in meansodium intake were observed between diagnosed and undiagnosed adults within the same blood pressure category in any guideline period or across any blood pressure category in the post-2017 period.</p> Conclusions <p>Despite reclassifying millions as hypertensive, the 2017 guideline was not associated with meaningful sodium reduction. Regardless of diagnosis status, adults across all blood pressure categories consumed well above recommended levels, with no consistent evidence that clinical diagnosis was associated with lower sodium intake within the same blood pressure category. These findings suggest that diagnostic reclassification without systematic implementation strategies may not be sufficient to drive dietary behavior change, highlighting the need for multi-level interventions addressing clinical care, food industry reformulation, and policy environment.</p>

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Sodium intake patterns among US adults before and after the 2017 ACC/AHA hypertension guidelines: evidence from NHANES 2013–2023

  • 期刊论文

  • 发表日期：

    2026年6月27日

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  • Oyefunmilayo S. Amoda,
  • Adam Branscum,
  • Josh M. Jorgensen,
  • Jennifer A. Jackson,
  • Ellen Smit

摘要

Purpose

The 2017 ACC/AHA hypertension guidelines lowered the diagnostic threshold to ≥ 130/80 mmHg, substantially increasing adults classified as hypertensive and emphasizing lifestyle modification, including sodium reduction as first-line management. However, whether this reclassification was associated with lower dietary sodium intake at the population level remains unclear.

Methods

We analyzed NHANES 2013–2023 data, classifying adults by blood pressure category under old (≥ 140/90 mmHg) and new (≥ 130/80 mmHg) hypertension definitions, applied retrospectively to 2013–2016 and to 2017–2023. Sodium intake was assessed via two 24-hour dietary recalls and compared across hypertension categories and diagnosis status using survey-weighted linear regression.

Results

Mean sodium intake exceeded 3,200 mg/day across all periods and blood pressure categories, approximately 40% above the maximum recommended levels of 2300mg/day. Adults consuming ≥ 2,300 mg/day declined modestly from 73.6% pre-2017 to 68.7% post-2017. After adjustment, no statistically significant differences in meansodium intake were observed between diagnosed and undiagnosed adults within the same blood pressure category in any guideline period or across any blood pressure category in the post-2017 period.

Conclusions

Despite reclassifying millions as hypertensive, the 2017 guideline was not associated with meaningful sodium reduction. Regardless of diagnosis status, adults across all blood pressure categories consumed well above recommended levels, with no consistent evidence that clinical diagnosis was associated with lower sodium intake within the same blood pressure category. These findings suggest that diagnostic reclassification without systematic implementation strategies may not be sufficient to drive dietary behavior change, highlighting the need for multi-level interventions addressing clinical care, food industry reformulation, and policy environment.