Feasibility and efficacy of sodium reduction in the trials of hypertension prevention, phase I

S. K. Kumanyika, P. R. Hebert, J. A. Cutler, V. I. Lasser, C. P. Sugars, L. Steffen- Batey, A. A. Brewer, M. Cameron, L. D. Shepek, N. R. Cook, S. T. Miller

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90 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)502-512
Number of pages11
JournalHypertension
Volume22
Issue number4
DOIs
StatePublished - 1993
Externally publishedYes

Keywords

  • blacks
  • blood pressure
  • hypertension, sodium-dependent
  • primary prevention
  • sodium, dietary
  • women

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    Kumanyika, S. K., Hebert, P. R., Cutler, J. A., Lasser, V. I., Sugars, C. P., Steffen- Batey, L., Brewer, A. A., Cameron, M., Shepek, L. D., Cook, N. R., & Miller, S. T. (1993). Feasibility and efficacy of sodium reduction in the trials of hypertension prevention, phase I. Hypertension, 22(4), 502-512. https://doi.org/10.1161/01.HYP.22.4.502