DCC participated in the processes of collecting data, performing

DCC participated in the processes of collecting data, performing the analysis and

writing the final research report. He was a comentor in FO’s doctoral training process. Funding: Data collection was funded by the International Development Research Centre (IDRC) under two project grants: EcoHealth Program #101810–001 and Global Health Leadership Award #103460-068. Personnel support was provided 3-Methyladenine 5142-23-4 for the lead author’s doctoral studies by the CAPES (Higher Education Training Coordination) program of the Government of Brazil. Competing interests: None. Patient consent: Obtained. Ethics approval: Bioethics Committee of the Ecuador National Health Council (T1) and the Internal Review Board of the Institute of Collective Health, Federal University of Bahia, Brazil. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
High blood pressure is responsible for about 170 000 deaths in India each year.1 India currently has an estimated 140 million people living with hypertension, a figure which is

projected to rise to 214 million by 2030. Habitual excess salt consumption2 is a main determinant of the disease burden ascribed to high blood pressure3 leading to many serious but avoidable complications, premature mortality and significant healthcare costs.4 In addition to the adverse effects of salt on blood pressure and vascular risk, a range of other serious health problems are also implicated including gastric cancer and osteoporosis.5 On the basis of the evidence linking salt,

blood pressure and vascular risk,6 7 the WHO recommends that all member states implement a salt reduction programme. A 30% lowering in the mean population salt intake by 2025 has been included as one of the targets of the ‘25 by 25’ United Nations–WHO initiative for the control of non-communicable diseases.8 Underpinning these recommendations are a number of comprehensive, authoritative reviews pertaining to the adverse effects of excess salt and the likely positive impact AV-951 of salt reduction.5 9–11 Some studies reporting on the health effects of salt and salt reduction have been inconclusive;12 13 however, there are various methodological problems with these studies as detailed by the Science Advisory of the American Heart Association.14 When the totality of the evidence is evaluated in an objective and systematic way, it is clear that most populations are eating salt far in excess of physiological requirements; many individuals suffer serious illnesses as a consequence, and there is a high likelihood that reduced salt intake would produce substantial health gains.5 15–19 A series of modelling exercises have highlighted the likely cost-effectiveness of national salt reduction strategies, with data for India suggesting a cost of less than Rs.

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