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Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II

Journal of Human Hypertension volume 19, pages 33–45 (2005)Cite this article

Abstract

Sodium reduction is efficacious for primary prevention of hypertension, but the feasibility of achieving this effect is unclear. The objective of the paper is detailed analyses of adherence to and effects of the sodium reduction intervention among overweight adults in the Trials of Hypertension Prevention, Phase II. Sodium reduction (comprehensive education and counselling about how to reduce sodium intake) was tested vs no dietary intervention (usual care) for 36–48 months. A total of 956 white and 203 black adults, ages 30–54 years, with diastolic blood pressure 83–89 mmHg, systolic blood pressure (SBP) <140 mmHg, and body weight 110–165% of gender-specific standard weight were included in the study. At 36 months, urinary sodium excretion was 40.4 mmol/24 h (24.4%) lower in sodium reduction compared to usual care participants (P<0.0001), but only 21% of sodium reduction participants achieved the targeted level of sodium excretion below 80 mmol/24 h. Adherence was positively related to attendance at face-to-face contacts. Net decreases in SBP at 6, 18, and 36 months of 2.9 (P<0.001), 2.0 (P<0.001), and 1.3 (P=0.02) mmHg in sodium reduction vs usual care were associated with an overall 18% lower incidence of hypertension (P=0.048); were relatively unchanged by adjustment for ethnicity, gender, age, and baseline blood pressure, BMI, and sodium excretion; and were observed in both black and white men and women. From these beneficial but modest results with highly motivated and extensively counselled individuals, sodium reduction sufficient to favourably influence the population blood pressure distribution will be difficult to achieve without food supply changes.

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Acknowledgements

Phase II of the Trials of Hypertension Prevention was supported by cooperative agreements HL 37852, HL 37924, HL 37907, HL 37904, HL 37854, HL 37849, HL 37884, HL 37853, HL 37899, and HL 37906 from the National, Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. We express our appreciation to Marilyn Chown and Rose Ungarelli at the TOHP II Coordinating Center for their assistance with statistical programming.

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Authors and Affiliations

  1. University of Pennsylvania School of Medicine, Philadelphia, USA

    S K Kumanyika

  2. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    N R Cook

  3. National Heart, Lung, and Blood Institute, Bethesda, MD, USA

    J A Cutler

  4. University of California School of Medicine, Davis, CA, USA

    L Belden

  5. University of Tennessee, Memphis, TN, USA

    A Brewer

  6. St. Louis (Missouri) University School of Medicine, MO, USA

    J D Cohen

  7. Yale University School of Medicine, New Haven, CT, USA

    P R Hebert

  8. New Jersey Medical School, Newark, NJ, USA

    V I Lasser

  9. University of Alabama, Birmingham, AL, USA

    J Raines

  10. College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    J Raczynski

  11. Southern Illinois Heart Institute, St. Elizabeth's Hospital, Belleville, IL, USA

    L Shepek

  12. Kaiser Permanente Center for Health Research, Portland, OR, USA

    L Diller

  13. Tulane University Health Sciences Center, New Orleans, LO, USA

    P K Whelton

  14. University of Pittsburgh, PA, USA

    M Yamamoto

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Correspondence to S K Kumanyika.

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Kumanyika, S., Cook, N., Cutler, J. et al. Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II. J Hum Hypertens 19, 33–45 (2005). https://doi.org/10.1038/sj.jhh.1001774

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