Hypertension, Vol 22, 502-512, Copyright © 1993 by American Heart Association
SK Kumanyika, PR Hebert, JA Cutler, VI Lasser, CP Sugars, L Steffen-Batey, AA Brewer, M Cameron, LD Shepek and NR Cook
Phase I of the Trials of Hypertension Prevention was a multicenter,
randomized trial of the feasibility and efficacy of seven nonpharmacologic
interventions, including sodium reduction, in lowering blood pressure in
30- to 54-year-old individuals with a diastolic blood pressure of 80 to 89
mm Hg. Six centers tested an intervention designed to reduce dietary sodium
to 80 mmol (1800 mg)/24 h with a total of 327 active intervention and 417
control subjects. The intervention consisted of eight group and two
one-to-one meetings during the first 3 months, followed by less-intensive
counseling and support for the duration of the study. The mean net decrease
in sodium excretion was 43.9 mmol/24 h at 18 months. Women had lower sodium
intake at baseline and were therefore more likely to decrease to less than
80 mmol/24 h. Black subjects were less likely to decrease to less than 80
mmol/d, independent of sex or baseline sodium excretion. The mean (95%
confidence interval) net decrease associated with treatment was -2.1 (-
3.3, -0.8) mm Hg for systolic blood pressure and -1.2 (-2.0, -0.3) mm Hg
for diastolic blood pressure at 18 months (both P < .01). Multivariate
analyses indicated a larger systolic blood pressure effect in women (-4.44
versus -1.23 mm Hg in men), adjusted for age, race, baseline blood
pressure, and baseline 24-hour urinary sodium excretion (P = .02).
Dose-response analyses indicated an adjusted decrease of - 1.4 mm Hg for
systolic blood pressure and -0.9 mm Hg for diastolic blood pressure for a
decrease of 100 mmol/24 h in 18-month sodium excretion. These results
support the utility of sodium reduction as a population strategy for
hypertension prevention and raise questions about possible differences in
dose response associated with gender and initial level of sodium intake.
ARTICLES
Feasibility and efficacy of sodium reduction in the Trials of Hypertension Prevention, phase I. Trials of Hypertension Prevention Collaborative Research Group
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.
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