hypertension control in shandong province improved since the 2002 national survey ()(16). However,hypertension control was much lower than that found in the united states and other countries(22,23). The low awereness of blood pressure levels is a crucial factor in hypertension control. Campaigns to increase blood pressure screening and detection should be emphasized in SMASH interventions. In addition,our study showed that among those aware of their hypertension, less than half (43.2%) had their blood pressure controlled. The lower control rate might be related to poor adherence to medication use(24). Health education on adherence to using antihypertension medication should be promoted by primary health service centers in the SMASH progrom. In addition, salt substitute, a salt with reduced sodium and increased potassium,is now being used in the china rural health initiative in 5 northern chinese provinces;if proved effective,using salt substitute might be a strategy to reduce sodium consumption and control hypertension(25).
We found dietary salt intake among shandong adults was high and changed little during the past 10 years. Reducing the population levels of salt intake is challenging. One major barrier is chaning the salty taste preference and appetite for current salt content typified by traditional shandong cuisine. Lowering salt content in food may lend to loss of palatability and may be unacceptable for individual taste preferences(26). However,gradual sodium reduction(10%-15% over multiple years) can be implemented and might lead to adjustment of the salf taste. This strategy was adopted by salt reduction programs in england and other countries(27,28). The food standards agency in england is working with the food industry progressively toward the 6-g-per-day salt intake target. We have adopted the same strategy in SMASH and plan to achieve salt-reduction goals by moderately and gradually reducing levels of salt fron high-sodium food.