Introduction: Hypertension is the most common diagnosis given by primary care physicians in the United States. Reductions in blood pressure can be achieved through lifestyle modifications, such as dietary sodium reduction. Previous studies indicate most adults in the United States who receive advice from their physician or health care provider to reduce their sodium take action, but only 13%-25% of all adults and 30%-60% of hypertensive adults report receiving advice.
Hypothesis: We hypothesized the majority of providers would report advising patients with hypertension to reduce their sodium intake and agree that most of their patients should reduce their sodium intake.
Methods: DocStyles is a national web-based survey of health care providers. In 2015, 465 family/general practitioners, 535 internists, and 251 nurse practitioners were asked questions about their practices related to sodium intake.
Results: A majority of providers agreed or strongly agreed with the statement, most of my patients should reduce their sodium intake (78%) and reported advising hypertensive patients (84%), pre-hypertensive patients (69%), and chronic kidney disease patients (71%) to “consume less salt.” Overall fewer providers reported advising diabetic patients (48%) and African-American patients (43%) to consume less salt. However, responses varied significantly by provider type. More than 50% of internists and nurse practitioners reported advising diabetic patients and 51% of nurse practitioners reported advising African-American patients to consume less salt. In addition, 41% of nurse practitioners reported advising all adults to consume less salt compared with 31% of family and general practitioners and 27% of internists. The most commonly reported advice given to patients to consume less salt was to eat less processed food (78%) and to read nutrition labels for sodium content (75%). A majority of providers reported their biggest barrier to reducing dietary sodium intake with hypertensive and pre-hypertensive patients was that “patients are unlikely to comply” (62%). The next most commonly reported barriers were “patients have more immediate health issues” (21%) and “lack of resources for patient education” (19%). Eighteen percent reported “no major barriers”, 14% reported lack of time, and 8% reported “not enough scientific evidence.”
Conclusion: Most providers agree their patients should reduce their sodium intake and advise patients with hypertension, pre-hypertension, and chronic kidney disease to reduce their intake. Advice was less likely to be reported for African-American and diabetic patients, who also are at high risk of cardiovascular disease. In conclusion, further effort and educational resources may be required to enable providers to effectively counsel their patients about salt reduction.