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Influence of Dietary Sodium Modulation on Electrocardiographic Voltage Criteria for Left Ventricular Hypertrophy in Normotensive Individuals
  1. Carol Larson, BS,
  2. Anand Vaidya, MD, MMSc,
  3. Bei Sun, MD, PhD,
  4. Jonathan S. Williams, MD, MMSc
  1. From the Division of Endocrinology, Diabetes, and Hypertension, Departmentof Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.
  1. Received July 21, 2011, and in revised form September 7, 2011.
  2. Accepted for publication October 6, 2011.
  3. Reprints: Anand Vaidya, MD, MMSc, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115. Email: avaidya1{at}
  4. Ms. Larson and Dr. Vaidya contributed equally to this work.
  5. Supported by F32 HL104776 (AV), K23 HL08236 (JSW), U54LM008748 from the National Library of Medicine and UL1 RR025758, Harvard Clinical and Translational Science Center, from the National Center for Research Resources and M01-RR02635, Brigham and Women’s Hospital, General Clinical Research Center, from the National Center for Research Resources, and the Specialized Center of Research (SCOR) in Molecular Genetics of Hypertension P50HL055000.
  6. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Library of Medicine, the National Institutes of Health, or the National Center for Research Resources.
  7. The authors have nothing to disclose.


Objective Dietary sodium intake and left ventricular hypertrophy (LVH) on electrocardiogram (ECG) are both independent determinants of cardiovascular risk. Prior studies demonstrated that acute dietary sodium modulation significantly altered LVH-specific ECG voltage in hypertensive individuals, thus modifying cardiovascular risk prediction; but whether this phenomenon exists in normotensive individuals is not known. We evaluated the influence of dietary sodium intake on ECG voltage and ECG criteria for LVH in normotensive individuals.

Methods Retrospective evaluation of ECGs of healthy normotensive individuals (n = 39) who were prospectively randomized to a dietary study protocol of 1 week of high-sodium diet (>200 mmol of sodium per day) and 1 week of low-sodium diet (<10 mmol/d) was conducted. Electrocardiogram voltage amplitudes and biochemical assessments were performed at the end of each dietary intervention.

Results As expected, blood pressure declined and measures of circulating renin-angiotensin-aldosterone system activity rose significantly with low-sodium diet. No significant changes in specific LVH voltage criteria or overall precordial or limb lead ECG voltage amplitudes were detected between diets.

Conclusion Although immediate dietary sodium modulation has been shown to significantly alter LVH-specific ECG voltage and the detection of LVH in hypertensive individuals, dietary sodium intake did not influence ECG voltage in normotensive individuals. Healthy normotensive individuals may exhibit adaptive measures that dampen ECG voltage fluctuations in response to dietary sodium modulation. More specific cardiac imaging studies may provide additional insight into this observation and the influence of dietary sodium in cardiac health.

Key Words
  • left ventricular hypertrophy
  • dietary sodium
  • electrocardiogram
  • rennin-angiotensin-aldosterone system

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