Recommendations issued on behalf of The Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, and the Chronic Disease Prevention Division, Centre for Chronic Disease Prevention and Control, Health Canada, do not include restricting salt intake for a majority of Canadians.

Six lifestyle recommendations to prevent hypertension (salt is number 5) include the following:

* Patients being treated for hypertension and "normotensive individuals at high risk for developing hypertension" who are also considered "salt sensitive" should limit sodium intake to 2,300 mg/day or less. The high risk normotensive population is a subset of individuals with diastolic blood pressures greater than 80 mm/Hg. Thus, individuals with diastolic blood pressure below 80 mm/Hg, the majority of the population, are excluded from any current need to restrict dietary salt. Also, individuals with diastolic blood pressure 80-89 mm/Hg who are not at high risk are also excluded from recommendations to restrict salt.

* Individuals should perform 30 min to 45 min of aerobic exercise on most days (four to five days) of the week

* Individuals should maintain an ideal body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2) and weight loss strategies should use a multidisciplinary approach

* Individuals should limit alcohol consumption to two drinks or fewer per day, and weekly intake should not exceed 14 standard drinks for men and nine standard drinks for women

* Individuals should choose a reduced fat, low cholesterol diet that emphasizes fruits, vegetables and low fat dairy products, and maintains an adequate intake of potassium, magnesium and calcium.

* Selected individuals should consider stress management intervention.

The recommendations were published this week in the Canadian Journal of Cardiology (Pulsus).

The Canadian Hypertension Education Program warns that none of the lifestyle modifications have yet been tested in health outcomes trials and that "long-term follow-up studies demonstrate that many patients fail to sustain lifestyle changes."

The recommendations are based only on blood pressure changes and were derived using pre-specified levels of evidence and included searches of the Cochrane Collaboration databases, the global standards organization in evidence-based medical decision-making.