FEASIBILITY AND EFFICACY OF SODIUM REDUCTION IN THE TRIALS OF HYPERTENSION PREVENTION, PHASE-I

被引:84
作者
KUMANYIKA, SK
HEBERT, PR
CUTLER, JA
LASSER, VI
SUGARS, CP
STEFFENBATEY, L
BREWER, AA
CAMERON, M
SHEPEK, LD
COOK, NR
MILLER, ST
机构
[1] JOHNS HOPKINS UNIV, SCH HYG & PUBL HLTH, DEPT EPIDEMIOL, BALTIMORE, MD 21218 USA
[2] HARVARD UNIV, SCH MED, BOSTON, MA 02115 USA
[3] BRIGHAM & WOMENS HOSP, DEPT MED, CHANNING LAB, BOSTON, MA 02115 USA
[4] NHLBI, DIV EPIDEMIOL & CLIN APPLICAT, PREVENT & DEMONSTRAT RES BRANCH, BETHESDA, MD 20892 USA
[5] UNIV MED & DENT NEW JERSEY, NEW JERSEY MED SCH, DEPT MED, PREVENT CARDIOL PROGRAM, NEWARK, NJ 07103 USA
[6] UNIV CALIF DAVIS, DEPT INTERNAL MED, DAVIS, CA 95616 USA
[7] UNIV MISSISSIPPI, JACKSON, MS 39216 USA
[8] ST LOUIS UNIV, SCH MED, ST LOUIS, MO 63104 USA
关键词
HYPERTENSION; SODIUM-DEPENDENT; BLOOD PRESSURE; SODIUM; DIETARY; PRIMARY PREVENTION; BLACKS; WOMEN;
D O I
10.1161/01.HYP.22.4.502
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
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.
引用
收藏
页码:502 / 512
页数:11
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