Centre for Environmental and Preventive Medicine
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Graham MacGregor is Professor of Cardiovascular Medicine at the Wolfson Institute of Preventive Medicine and Honorary Consultant at Barts & The London (Barts Health NHS Trust).
He is a visiting Professor of Cardiovascular Medicine at St George's Hospital Medical School, London.
With the inhibitors of the renin-angiotensin system developed in the late 1970s it was possible to explore the physiological and pathological role of the relationship between sodium and water balance, blood pressure control and the renin-angiotensin system. At Charing Cross the studies under metabolic conditions either as inpatients or outpatients allowed well controlled studies of the new blockers of the renin-angiotensin system as well calcium antagonists which had recently been introduced for the treatment of hypertension were done. At the same time, very carefully controlled studies of lifestyle changes, particularly looking at changing salt and potassium intake as well as magnesium and calcium were conducted.
Even in the 1970s there were controversies about salt, mainly funded by the salt industry. In view of this Professor MacGregor set up the first double blind studies of salt reduction which clearly showed that reducing salt intake by modest amounts had large effects on lowering blood pressure both on its own and in conjunction with pharmacological treatment.
In the mid-90s, the Conservative government - after initially accepting the recommendations from the COMA (Committee on Medical Aspects of Food Policy) report on what could be done with changing the diet to prevent cardiovascular disease which included many recommendations, one of which was salt reduction - subsequently rejected the recommendations on reducing salt intake following pressure from the food industry. This caused outrage amongst many blood pressure specialists which led Professor MacGregor to set up the action group on salt, “Consensus Action on Salt and Health” (CASH), with his colleagues. The objective was to try to get the food industry to slowly reduce the amount of salt they add to their products and thereby reduce population salt intake.
This action group was very successful in getting wide publicity about salt and resulted in the Food Standards Agency, when it was formed in 1999, taking on the task of salt reduction. Since then CASH has worked closely with the Food Standards Agency and pioneered with them a very successful salt reduction policy. Unfortunately when the Conservative Coalition government came to power in 2010 Andrew Lansley took responsibility for nutrition away from the Food Standards Agency back to the Department of Health and this dealt a severe blow to salt reduction in the UK where it was leading the world.
Based on the success of the UK, he set up an international action group on salt in 2005, World Action on Salt and Health (WASH), which now has over 500 members in 100 countries. The group has been very successful in spreading the message about trying to get salt reduction programmes set up in different countries, working closely with the World Health Organisation (WHO) and with individuals in each country who have set up their own action groups. This has meant that most countries now have, or are planning to have, salt reduction policies, many of them copying the UK experience and adapting it to their own particular circumstances. The UK salt reduction policy is very cost-effective.
In 2014, after trying to get other NGOs together to set up an obesity / type 2 diabetes prevention programme unsuccessfully, he decided to set up his own group, Action on Sugar, which has successfully campaigned to get a coherent plan to prevent obesity and type 2 diabetes, initially in the UK. The aim, as happened with the successful salt programme in the UK, would be to spread this out internationally.
In 2000 he set up the Blood Pressure Association (now Blood Pressure UK), a patients’ association for high blood pressure to get better information to patients and to lobby for better prevention and treatment of high blood pressure. This has been very successful in the UK, and won the Charity of the Year Award in 2008. It also runs an annual Know Your Numbers campaign where more than 250,000 people have their blood pressure measured throughout the UK.
He has served on many other medical organisations including the World Hypertension League board where he remains as an advisor on salt reduction, the WHO and its regional offices, and was also one of the Founders and subsequently the President, of the British Hypertension Society.
For more information see:
Total peer reviewed: over 400
Selected publications related to salt:
School based education programme to reduce salt intake in children & their families (School-EduSalt): cluster randomised controlled trial. He FJ, Wu Y, Feng XX, Ma J, Ma Y, Wang H, Zhang J, Yuan J, Lin CP, Nowson C, MacGregor GA.BMJ. 2015 Mar 18;350:h770. doi: 10.1136/bmj.h770.
Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke & ischaemic heart disease mortality. He FJ, Pombo-Rodrigues S, Macgregor GA. BMJ Open. 2014 Apr 14;4(4):e004549. doi: 10.1136/bmjopen-2013-004549.
Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review & meta-analysis of randomised trials. He FJ, Li J, Macgregor GA. BMJ. 2013 Apr 3;346:f1325. doi: 10.1136/bmj.f1325.
Reducing population salt intake worldwide: from evidence to implementation. He FJ, MacGregor GA. Prog Cardiovasc Dis. 2010 Mar-Apr;52(5):363-82. doi: 10.1016/j.pcad.2009.12.006.
Plasma sodium stiffens vascular endothelium & reduces nitric oxide release. Oberleithner H, Riethmuller C, Schillers H, MacGregor GA, de Wardener HE, Hausberg M. Proc Natl Acad Sci U S A. 2007 Oct 9;104(41):16281-6.
Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. He FJ, MacGregor GA. Hypertension. 2006 Nov;48(5):861-9.
Fruit & vegetable consumption & stroke: meta-analysis of cohort studies. He FJ, Nowson CA, MacGregor GA. Lancet. 2006 Jan 28;367(9507):320-6.
Double-blind study of three sodium intakes & long-term effects of sodium restriction in essential hypertension. MacGregor GA, Markandu ND, Sagnella GA, Singer DR, Cappuccio FP. Lancet. 1989 Nov 25;2(8674):1244-7.
Double-blind randomised crossover trial of moderate sodium restriction in essential hypertension. MacGregor GA, Markandu ND, Best FE, Elder DM, Cam JM, Sagnella GA, Squires M. Lancet. 1982 Feb 13;1(8268):351-5.
Maintenance of blood pressure by the renin-angiotensin system in normal man. MacGregor GA, Markandu ND, Roulston JE, Jones JC, Morton JJ. Nature. 1981 May28;291(5813):329-31.