Professor Graham MacGregor

Profile

I am Professor of Cardiovascular Medicine at the Wolfson Institute of Population Health and Honorary Consultant at Barts & The London (Barts Health NHS Trust). I am a visiting Professor of Cardiovascular Medicine at St George's Hospital Medical School, London.

Research

Research Interests:

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. 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, I 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 me to set up the action group on salt, 'Consensus Action on Salt and Health' (CASH), with 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, I 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, I decided to set up my own group, 'Action on Sugar', which has successfully campaigned to develop 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, I 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.

I have served on many other medical organisations, including the World Hypertension League board where I remain an advisor on salt reduction, the WHO and its regional offices, and I was also one of the Founders, and subsequently the President, of the British Hypertension Society.

For more information see:

• http://www.actiononsalt.org.uk/
• http://www.worldactiononsalt.com/
• http://www.actiononsugar.org/
• http://www.bloodpressureuk.org/Home

Publications

Please click through to see a complete list of Graham's publications.

Featured publications

He FJ, Zhang P, Luo R, Li Y, Sun Y, Chen F, Zhao Y, Zhao W, Li D, Chen H, Wu T, Yao J, Lou C, Zhou S, Dong L, Liu Y, Li X, He Jing, Wang C, Tan M, Song J, MacGregor GA. App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial. BMJ. 2022; 376. doi: 10.1136/bmj-2021-066982

Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, MacGregor GA, Bakker SJL, Campbell NRC, Wang M, Rimm EB, Manson JE, Willett WC, Hofman A, Gansevoort RT, Cook NR, Hu FB. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk. N Engl J Med. 2022; 386(3):252-263.

He FJ, Tan M, Ma Y, MacGregor GA, (2020). Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 75 (6).

He FJ, Zhang P, Li Y, MacGregor GA, Action on Salt China. Lancet. 2018;392:7-9.

Ma Y, He FJ, Yin Y, Hashem KM, MacGregor GA. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study. Lancet Diabetes Endocrinol. 2016;4:105-114.

Supervision

• Mhairi Brown: An evaluation of reformulation policy in the UK: the successes, barriers and opportunities for salt and sugar reduction. Start date: 12 October 2020.
• Roberta Alessandrini: Reducing total and saturated fat for lowering food energy density: potential health impacts of a gradual reformulation strategy in the UK. Start date: 8 January 2018.
• María Isabel Valero Morales: Salt intake in Mexico and a pilot salt reformulation programme. Start date: 1 October 2019.