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Effects of environmental and genetic risk factors for salt sensitivity on blood pressure in northern China: the systemic epidemiology of salt sensitivity (EpiSS) cohort study
  1. Han Qi1,
  2. Bin Liu1,
  3. Chunyue Guo1,
  4. Zheng Liu1,
  5. Han Cao1,
  6. Kuo Liu1,
  7. Weiping Sun2,
  8. Ling Zhang1
  1. 1 Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
  2. 2 Department of Cardiology, Luhe Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Professor Ling Zhang; zlilyepi{at}


Purpose The systemic epidemiology of salt sensitivity (EpiSS) study aims to combine molecular biology, epidemiology and bioinformatics methods to discover the potential causes of salt sensitivity of blood pressure (SSBP) using single-nucleotide polymorphisms in the genome and non-coding RNAs in the transcriptome to uncover both the genetic and environmental factors of SSBP.

Participants Between July 2014 and July 2016, we enrolled adults from 11 study centres in Beijing and Liaoning Province; participants were of the Han population and were 35–70 years of age. We collected blood samples, spot urine samples and 24-hour urine samples, in addition to baseline data on demographics, health-related lifestyle factors, chronic diseases, family history of illness and anthropometric information through face-to-face interviews using a standardised questionnaire. EpiSS uses the modified Sullivan’s acute oral saline load and diuresis shrinkage test (MSAOSL-DST) to evaluate the effects of salt on blood pressure.

Findings to date In total, 2163 participants were included in the EpiSS, of which 2144 participants completed the questionnaire, 2120 (98.0%) completed the MSAOSL-DST and 2083 (96.3%) provided a 24-hour urine sample. A total of 2057 participants (1501 women and 556 men) completed all the steps of the investigation and were included in the analysis. Among them, 583 (28.3%) subjects were classified as having salt sensitivity of blood pressure, and 1061 (51.6%) had hypertension.

Future plans The next step of our study is to evaluate the incidence of cardiovascular disease in the participants. Biennial follow-up, including face-to-face questionnaire surveys, laboratory measurements of blood, urinary creatinine, glomerular filtration rate and anthropometric measurements, will occur two additional times. DNA and RNA will be collected for subsequent genetic biomarker studies. We plan on screening the salt-sensitive-related gene loci and non-coding RNAs based on relative environmental risk factors.

Trial registration number ChiCTR-EOC-16009980; Pre-results.

  • blood pressure
  • dietary sodium
  • genes
  • salt sensitivity
  • epidemiology

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  • Patient consent for publication Obtained.

  • Contributors HQ and BL designed and performed the epidemiology field survey in Beijing and Liaoning Province, carried out staff training, registered the project in the WHO clinical trial platform and wrote the manuscript. HQ, BL, CG, ZL, HC, KL and WS performed the field study and collected and analysed the data. HQ, CG and KL revised the manuscript. LZ obtained funding, supervised the overall study process and revised the manuscript. All authors read and approved the final manuscript.

  • Funding This work was financially supported by the National Natural Science Foundation of China (grant no. 81373076), the National Key Research and Development Program of China (grant no. 2016YFC0900603), the Natural Science Foundation of Beijing Municipality (grant no. 7172023) and the Importation and Development of High-Caliber Talent Project of Beijing Municipal Institutions (grant no. CIT&TCD201504088).

  • Competing interests None declared.

  • Ethics approval EpiSS obtained the approval of the Capital Medical University ethics committee (no. 2013SY22).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets collected and/or analysed during the study are available from the corresponding author on reasonable request. We welcome potential collaborators and researchers who are interested in independently investigating specific questions regarding the EpiSS study. Therefore, we hope to receive valuable suggestions from collaborators and researchers in order to obtain the full value from our cohort data.

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