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This article explores the role of reducing dietary sodium in lowering blood pressure and preventing cardiovascular disease (CVD). It acknowledges that high sodium consumption, particularly in processed foods, is a significant contributor to CVD-related health issues worldwide. The article provides evidence supporting the connection between sodium intake and blood pressure, as well as the link between sodium intake and CVD events. It emphasizes the importance of sodium reduction throughout different stages of life and presents population-level evidence of the effectiveness of sodium reduction in lowering blood pressure and potentially preventing CVD. The article concludes that while other approaches, such as increasing potassium intake, can be helpful, reducing sodium is a central aspect of effective public policy in reducing hypertension and preventing CVD. The authors also suggest that public health initiatives should focus on regulating industry practices to reduce sodium in processed foods and promoting education and salt substitution in countries with high sodium consumption from home cooking. They argue that nationwide sodium reduction policies are crucial for preventing CVD. [Extracted from the article]

BACKGROUND: Management of orthostatic hypotension (OH) prioritizes prevention of standing hypotension, sometimes at the expense of supine hypertension. It is unclear whether supine hypertension is associated with adverse outcomes relative to standing hypotension. OBJECTIVES: To compare the long-term clinical consequences of supine hypertension and standing hypotension among middle-aged adults with and without OH. METHODS: The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing blood pressure (BP) in adults aged 45 to 64 years, without neurogenic OH, between 1987 and 1989. We defined OH as a positional drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, supine hypertension as supine BP≥140/≥90 mm Hg, and standing hypotension as standing BP≤105/≤65 mm Hg. Participants were followed for >30 years. We used Cox regression models to examine associations with cardiovascular disease events, all-cause mortality, falls, and syncope. RESULTS: Of 12 489 participants (55% female, 26% Black, mean age 54 years, SD 6), 4.4% had OH. Among those without OH (N=11 943), 19% had supine hypertension and 21% had standing hypotension, while among those with OH (N=546), 58% had supine hypertension and 38% had standing hypotension. Associations with outcomes did not differ by OH status (P-interactions >0.25). Supine hypertension was associated with heart failure (hazard ratio, 1.83 [95% CI, 1.68-1.99]), falls (hazard ratio, 1.12 [95% CI, 1.02-1.22]), and all-cause mortality (hazard ratio, 1.45 [95% CI, 1.37-1.54]), while standing hypotension was only significantly associated with mortality (hazard ratio, 1.06 [95% CI, 1.00-1.14]). CONCLUSIONS: Supine hypertension was associated with higher risk of adverse events than standing hypotension, regardless of OH status. This challenges conventional OH management, which prioritizes standing hypotension over supine hypertension. [ABSTRACT FROM AUTHOR]

BACKGROUND ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits. METHODS The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45–64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex. RESULTS Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex. CONCLUSIONS In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events. [ABSTRACT FROM AUTHOR]

Reticence is often over-determined, so Ian Ground's explanation of why Wittgenstein's private notebooks were slow to see the light of day, 'that his generation just thought it rather vulgar, intrusive [...]

Hypertension is among the most prevalent medical conditions globally and a major contributor to chronic kidney disease, cardiovascular disease, and death. Prevention through nonpharmacological, population-level interventions is critically needed to halt this worldwide epidemic. However, there are ongoing disagreements as to where public policy efforts should focus. Recently the Salt Substitute and Stroke Study demonstrated the efficacy of substituting table salt with potassium salt to reduce the risk of stroke, major cardiovascular events, and death. However, this sparked debate over whether sodium or potassium should be prioritized in countries where table salt substitution was less feasible. In this commentary, we summarize arguments in favor of either strategy: reduced sodium or increased potassium intake. Moreover, we discuss evidence and policy approaches related to either or combined approaches relevant to cultural context. Ultimately, there is an urgent need for policies that both reduce sodium and increase potassium intake; however, identifying a strategy that fits cultural context will be key to improve populationwide blood pressures. [ABSTRACT FROM AUTHOR]

Adam Mars-Jones is only half right in describing West Side Story (1961) as Robert Wise's film (December 10). The co-director was Jerome Robbins, who won an Academy award, along with [...]

An examination of late Rorty shows that he does not abandon belief in an external world about which we can, and indeed must, acquire knowledge. His disapproval of the correspondence theory of truth does not involve the idea that anything other than local weather, for example, could falsify remarks about local weather. It is just that once we get done looking out the window or, if we are outside, feeling the right kind of drops make contact with our skin, there is nothing else we can do, nothing better, to make ourselves more certain, more cognitively secure. One can see this in the detailed work that enables scientific progress. Science improves itself by doing more of the same. G. E. Moore's famous open question stays open only as a reminder that our fallibility never disappears and that our cognitive security is never better than pro tem. Rorty, as a faithful pragmatist and undogmatic meliorist, thinks this is perfectly O.K. [ABSTRACT FROM AUTHOR]