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The PURE abstraction enrolled 157,543 adults 35 to 70 years of age from 667 communities in 18 low-, middle-, and advantageous countries on 5 continents9,10 (for capacity on actor selection, see the Methods breadth in the Supplementary Appendix, accessible with the abounding argument of this commodity at NEJM.org). Countries were called from four assets strata according to the World Bank allocation in 2006 on the base of gross civic assets per capita: 4 low-income countries (Bangladesh, India, Pakistan, and Zimbabwe), 4 lower-middle-income countries (China, Colombia, Iran, and the Occupied Palestinian Territory), 7 upper-middle-income countries (Argentina, Brazil, Chile, Malaysia, Poland, South Africa, and Turkey), and 3 advantageous countries (Canada, Sweden, and the United Arab Emirates). The final abstraction sample comprised 102,216 participants with a accurate baseline abnegation morning urine sample, of whom 42% were from China. Baseline characteristics of the participants in our abstraction were about agnate to the characteristics of the participants in the all-embracing PURE abstraction (Table 1).
On accession at the dispensary in the morning, anniversary actor provided a abnegation midstream urine specimen, which was arctic at −20 to −70°C. All samples were alien in ambient packaging with the use of STP-250 aircraft boxes (Saf-T-Pak) to the Clinical Research and Clinical Trials Class at Hamilton General Hospital in Hamilton, Ontario, Canada (the axial class for 15 countries), or to a bounded class in Beijing; Bangalore, India; or Kocaeli, Turkey, for analyses with the use of connected methods. Physical appraisal of anniversary actor included weight, height, and two recordings of comatose claret burden with the use of the Omron HEM-757 automated agenda adviser (Omron Healthcare). The methods acclimated to accomplish urinary analyses and blood-pressure abstracts are declared in the Methods breadth in the Supplementary Appendix. Information on medical history and use of medications was recorded.
We acclimated the Kawasaki formula11,12 to appraisal 24-hour urinary elimination of sodium and potassium from a abnegation morning case and acclimated these estimates as surrogates for sodium and potassium intake. A validation abstraction of the Kawasaki blueprint complex 1083 bodies from 11 countries (Fig. S1 and S2 and Table S1 in the Supplementary Appendix).13 This abstraction showed an intraclass alternation accessory of 0.71 (95% aplomb breach [CI], 0.65 to 0.76) for the Kawasaki appraisal against abstinent 24-hour sodium excretion. In addition assay from the aforementioned study, the beggarly claret burden akin at capricious levels of sodium elimination was agnate for Kawasaki-estimated and 24-hour abstinent elimination (for systolic claret pressure, 127.4 mm Hg and 128.3 mm Hg, respectively, at <3 g of sodium per day; 129.0 mm Hg and 129.5 mm Hg at 3 to 5 g per day; and 137.7 mm Hg and 135.0 mm Hg at >5 g per day), and the accord of both measures with claret burden was additionally agnate (P<0.001 for anniversary trend).13
The abstraction was advised by the aftermost columnist and was supervised by the third and aftermost authors calm with the appointed baton in anniversary country (see the Supplementary Appendix). All analyses were performed by the aboriginal author. The aboriginal columnist assumes albatross for the analyses and estimation of abstracts and wrote the aboriginal abstract of the arrangement with the additional and aftermost authors.
The PURE abstraction was adjourned by nonprofit, government, and industry sponsors. The funders of the abstraction had no role in its architecture or conduct, in the collection, analysis, or estimation of the data, or in the autograph of the manuscript. The abstraction was accustomed by the belief committees at all accommodating centers and at Hamilton Health Sciences, Hamilton, Ontario, Canada. All participants provided accounting abreast consent.
Mean (±SD) estimated sodium elimination and potassium elimination were computed for the absolute accomplice and according to , burghal against rural area, country assets level, and geographic arena (Africa, China, Malaysia, the Middle East, North America and Europe, South America, and South Asia), with acclimation for age and area appropriate. Multivariable beeline corruption was acclimated to appraise the affiliation amid electrolyte elimination and claret pressure. We affected the aberration in systolic and diastolic claret burden per 1 g (43.5 mmol) of sodium elimination or 1 g (25.6 mmol) of potassium excretion. Participants were categorized into groups on the base of increments of 1 g per day in urinary sodium elimination and increments of 0.25 g per day in potassium excretion. Assay of covariance was performed, with tests for beeline trend, to analyze the beggarly claret burden amid groups authentic on the base of sodium elimination or potassium excretion, with acclimation for covariates accepted to be associated with claret pressure, including age, , educational level, body-mass index, booze intake, and geographic region. In assessing associations of sodium elimination with claret pressure, we advised the access of age, geographic location, hypertension status, booze intake, body-mass index, and potassium excretion, application tests of interaction. The aftereffect of sodium or potassium elimination on claret burden was added evaluated at altered levels of sodium or potassium excretion.
To analyze the aftereffect of corruption concoction bias, we conducted a accessory assay application the estimated “usual” elimination of sodium and potassium, as declared by the Prospective Studies Collaboration14 (the corruption concoction arrangement was affected on the base of baseline altitude and remeasurement at 30 to 90 canicule in 448 participants). We acclimated beeline corruption to appraise the affiliation of the urinary sodium-to-potassium arrangement
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