Drinking Water NaCl Is Associated With Hypertension and Albuminuria: A Panel Study

Asher Y Rosinger^{1

2

3}, Amanda McGrosky^{3

4}, Hannah Jacobson^{3

5}, Elena Hinz^{3

6}, Srishti Sadhir^{3

6}, Faith Wambua³, Tom Otube⁷, Lilian J Baker^{3

8}, Alison C Sherwood³, Tiffany Chrissy-Mbeng^{3

9}, Lauren M T Broyles^{1

10}, Carey Musumeci¹, Natalie C Meriwether¹, Nicole Bobbie¹, Zoë Farrar¹, Madeleine Todd¹, Zee Nguyen¹, Gabriella Berger¹, Leslie B Ford^{1

3}, David R Braun^{3

11}, Michael D Hunter¹², Matthew J Douglass^{3

13}, William B Farquhar¹⁴, W Larry Kenney¹⁵, Jeff M Sands¹⁶, Rosemary Nzunza¹⁷, Emmanuel K Ndiema³, Herman Pontzer^{3

6

17}

Affiliations

¹ Department of Biobehavioral Health (A.Y.R., L.M.T.B., C.M., N.C.M., N.B., Z.F., M.T., Z.N., G.B., L.B.F.), Pennsylvania State University, University Park, PA.
² Department of Anthropology (A.Y.R.), Pennsylvania State University, University Park, PA.
³ Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya (A.Y.R., A.M.G., H.J., E.H., S.S., F.W., L.J.B., A.C.S., T.C.-M., L.B.F., D.R.B., M.J.D., E.K.N., H.P.).
⁴ Department of Biology, Elon University, Elon, NC (A.M.G.).
⁵ Department of Anthropology, Northwestern University, Evanston, IL (H.J.).
⁶ Department of Evolutionary Anthropology, Duke University, Durham, NC (E.H., S.S., H.P.).
⁷ Koobi Fora Field School, Kenya (T.O.).
⁸ Department of Anthropology, Vanderbilt University, Nashville, TN (L.J.B.).
⁹ Department of Anthropology (A.S., T.C.-M.), The George Washington University, DC.
¹⁰ Population Research Institute, Pennsylvania State University, University Park, PA (L.M.T.B.).
¹¹ Center for the Advanced Study of Human Paleobiology, Department of Anthropology (D.R.B.), The George Washington University, DC.
¹² Department of Human Development and Family Studies (M.D.H.), Pennsylvania State University, University Park, PA.
¹³ College of Agricultural Sciences and Natural Resources, University of Nebraska-Lincoln, NE (M.J.D.).
¹⁴ Department of Kinesiology and Applied Physiology, University of Delaware, Newark (W.B.F.).
¹⁵ Department of Kinesiology (W.L.K.), Pennsylvania State University, University Park, PA.
¹⁶ Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA (J.M.S.).
¹⁷ Center for Virus Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya (R.N., H.P.). Global Health Institute, Duke University, Durham, NC.

PMID: 40552420
PMCID: PMC12270478 (available on 2026-06-24)
DOI: 10.1161/HYPERTENSIONAHA.125.24751

Drinking Water NaCl Is Associated With Hypertension and Albuminuria: A Panel Study

Asher Y Rosinger et al. Hypertension. 2025 Aug.

. 2025 Aug;82(8):1368-1378.

doi: 10.1161/HYPERTENSIONAHA.125.24751. Epub 2025 Jun 24.

Authors

Affiliations

¹ Department of Biobehavioral Health (A.Y.R., L.M.T.B., C.M., N.C.M., N.B., Z.F., M.T., Z.N., G.B., L.B.F.), Pennsylvania State University, University Park, PA.
² Department of Anthropology (A.Y.R.), Pennsylvania State University, University Park, PA.
³ Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya (A.Y.R., A.M.G., H.J., E.H., S.S., F.W., L.J.B., A.C.S., T.C.-M., L.B.F., D.R.B., M.J.D., E.K.N., H.P.).
⁴ Department of Biology, Elon University, Elon, NC (A.M.G.).
⁵ Department of Anthropology, Northwestern University, Evanston, IL (H.J.).
⁶ Department of Evolutionary Anthropology, Duke University, Durham, NC (E.H., S.S., H.P.).
⁷ Koobi Fora Field School, Kenya (T.O.).
⁸ Department of Anthropology, Vanderbilt University, Nashville, TN (L.J.B.).
⁹ Department of Anthropology (A.S., T.C.-M.), The George Washington University, DC.
¹⁰ Population Research Institute, Pennsylvania State University, University Park, PA (L.M.T.B.).
¹¹ Center for the Advanced Study of Human Paleobiology, Department of Anthropology (D.R.B.), The George Washington University, DC.
¹² Department of Human Development and Family Studies (M.D.H.), Pennsylvania State University, University Park, PA.
¹³ College of Agricultural Sciences and Natural Resources, University of Nebraska-Lincoln, NE (M.J.D.).
¹⁴ Department of Kinesiology and Applied Physiology, University of Delaware, Newark (W.B.F.).
¹⁵ Department of Kinesiology (W.L.K.), Pennsylvania State University, University Park, PA.
¹⁶ Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA (J.M.S.).
¹⁷ Center for Virus Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya (R.N., H.P.). Global Health Institute, Duke University, Durham, NC.

PMID: 40552420
PMCID: PMC12270478 (available on 2026-06-24)
DOI: 10.1161/HYPERTENSIONAHA.125.24751

Abstract

Background: Salt leaching into freshwater is an emerging global environmental health concern. We tested the associations between drinking water salinity and blood pressure, hypertension, and albuminuria.

Methods: We conducted a 2-year panel study in 2022 and 2023 with 434 observations among 327 Daasanach adults aged >18 years in northern Kenya. Water sources were analyzed for overall salinity and ionic composition (sodium; chloride; calcium, potassium, magnesium). We measured resting blood pressure and classified hypertension stage 1 and stage 2. Urine samples were analyzed for albuminuria (≥30 mg/g albumin-to-creatinine ratio).

Results: Drinking water salinity was driven by sodium-chloride (mean=162.6 mg/L, SD=77.1), with low concentrations of calcium, potassium, and magnesium (mean=45 mg/L, SD=13.5). Across 2022 and 2023, 40.1% of adults had at least hypertension stage 1, 13.5% had hypertension stage 2, and 42.2% had albuminuria. Using random effects linear and logistic panel regressions fully adjusted for confounders, each 100 mg/L of drinking water sodium-chloride was associated with 4.5 mm Hg (95% CI, 2.4-6.6) and 3.3 mm Hg (95% CI, 2.2-4.5) increases in systolic and diastolic blood pressure, 3.0× the odds of at least hypertension stage 1 (95% CI, 1.49-5.83), 3.6× the odds of hypertension stage 2 (95% CI, 1.93-6.81), and 2.0× the odds of albuminuria (95% CI, 1.28-3.06). Calcium, potassium, and magnesium were unassociated with any outcomes. Hypertension stage 2 (but not hypertension stage 1) was associated with 2.6× (95% CI, 1.19-5.77) the odds of albuminuria.

Conclusions: Drinking water sodium-chloride was associated with resting blood pressure, hypertension, and albuminuria in a population with few traditional lifestyle risk factors for chronic disease. Measuring specific salts in water helps untangle associations with hypertension.

Keywords: albuminuria; blood pressure; drinking water; hypertension; sodium chloride; water salinity.

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Conflict of interest statement

J.M. Sands is also chief medical officer in NephroDI Therapeutics, which is unassociated with this research. The other authors report no conflicts.

References

1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, Alexander L, Estep K, Hassen Abate K, Akinyemiju TF, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–182. doi: 10.1001/jama.2016.19043 - DOI - PubMed
1. Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Aboyans V, Adetokunboh O, Afshin A, Agrawal A. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390:1151–1210. - PMC - PubMed
1. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY-M, Yang C-W. Chronic kidney disease: global dimension and perspectives. The Lancet. 2013;382:260–272. doi: 10.1016/S0140-6736(13)60687-X - DOI - PubMed
1. Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392:1923–1994. doi: 10.1016/S0140-6736(18)32225-6 - DOI - PMC - PubMed
1. Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary Sodium and Health. Journal of the American College of Cardiology. 2015;65:1042–1050. doi: doi: 10.1016/j.jacc.2014.12.039 - DOI - PMC - PubMed

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Drinking Water NaCl Is Associated With Hypertension and Albuminuria: A Panel Study

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Drinking Water NaCl Is Associated With Hypertension and Albuminuria: A Panel Study

Authors

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Conflict of interest statement

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