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Effects of Reduced Sodium Intake on Hypertension Control in Older Individuals: Results From the Trial of Nonpharmacologic Interventions in the Elderly (TONE)
Abstract
BACKGROUND: Few trials have evaluated the effects of reduced sodium intake in older individuals, and no trial has examined the effects in relevant subgroups such as African Americans. PATIENTS AND METHODS: The effects of sodium reduction on blood pressure (BP) and hypertension control were evaluated in 681 patients with hypertension, aged 60 to 80 years, randomly assigned to a reduced sodium intervention or control group. Participants (47% women, 23% African Americans) had systolic BP less than 145 mm Hg and diastolic BP less than 85 mm Hg while taking 1 antihypertensive medication. Three months after the start of intervention, medication was withdrawn. The primary end point was occurrence of an average systolic BP of 150 mm Hg or more, an average diastolic BP of 90 mm Hg or more, the resumption of medication, or a cardiovascular event during follow-up (mean, 27.8 months). RESULTS: Compared with control, mean urinary sodium excretion was 40 mmol/d less in the reduced sodium intervention group (P<.001); significant reductions in sodium excretion occurred in subgroups defined by sex, race, age, and obesity. Prior to medication withdrawal, mean reductions in systolic and diastolic BPs from the reduced sodium intervention, net of control, were 4.3 mm Hg (P<.001) and 2.0 mm Hg (P =.001). During follow-up, an end point occurred in 59% of reduced sodium and 73% of control group participants (relative hazard ratio = 0.68, P<.001). In African Americans, the corresponding relative hazard ratio was 0.56 (P =.005); results were similar in other subgroups. In dose-response analyses, end points were progressively less frequent with greater sodium reduction (P for trend =.002). CONCLUSION: A reduced sodium intake is a broadly effective, nonpharmacologic therapy that can lower BP and control hypertension in older individuals.
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Citations
Cites
Nonpharmacologic Intervention to Reduce Blood Pressure in Older Patients With Mild Hypertension
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Cited by
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., et al. (2003) · Hypertension · doi:10.1161/01.hyp.0000107251.49515.c2 · Cited by 13,271
Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Miller, N. H., Hubbard, V. S., Lee, I.-M., Lichtenstein, A. H., Loria, C. M., Millen, B. E., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437740.48606.d1 · Cited by 2,261
Appel, L. J., Brands, M. W., Daniels, S. R., Karanja, N., Elmer, P. J., & Sacks, F. M. (2006) · Hypertension · doi:10.1161/01.hyp.0000202568.01167.b6 · Cited by 1,304
Self-citationCook, N. R., Cutler, J. A., Obarzanek, E., Buring, J. E., Rexrode, K. M., Kumanyika, S. K., Appel, L. J., & Whelton, P. K. (2007) · BMJ · doi:10.1136/bmj.39147.604896.55 · Cited by 1,179
Self-citation2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Houston Miller, N., Hubbard, V. S., Lee, I.-M., Lichtenstein, A. H., Loria, C. M., Millen, B. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.003 · Cited by 1,160
The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide
Fields, L. E., Burt, V. L., Cutler, J. A., Hughes, J., Roccella, E. J., & Sorlie, P. (2004) · Hypertension · doi:10.1161/01.hyp.0000142248.54761.56 · Cited by 906
Reducing population salt intake worldwide: from evidence to implementation
He, F. J., & MacGregor, G. A. (2010) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2009.12.006 · Cited by 625
The Aging Cardiovascular System
Paneni, F., Diaz Cañestro, C., Libby, P., Lüscher, T. F., & Camici, G. G. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.01.064 · Cited by 618
Graudal, N. A., Hubeck-Graudal, T., & Jurgens, G. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004022.pub4 · Cited by 620
Salt Reduction to Prevent Hypertension and Cardiovascular Disease
He, F. J., Tan, M., Ma, Y., & MacGregor, G. A. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.11.055 · Cited by 589
Landsberg, L., Aronne, L. J., Beilin, L. J., Burke, V., Igel, L. I., Lloyd‐Jones, D., & Sowers, J. (2013) · The Journal of Clinical Hypertension · doi:10.1111/jch.12049 · Cited by 528
Graudal, N., Jürgens, G., Baslund, B., & Alderman, M. H. (2014) · American Journal of Hypertension · doi:10.1093/ajh/hpu028 · Cited by 407
Patnode, C. D., Evans, C. V., Senger, C. A., Redmond, N., & Lin, J. S. (2017) · JAMA · doi:10.1001/jama.2017.3303 · Cited by 380
Mayer-Davis, E. J., D'Antonio, A. M., Smith, S. M., Kirkner, G., Levin Martin, S., Parra-Medina, D., & Schultz, R. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.10.1736 · Cited by 202
Web-based weight loss in primary care: a randomized controlled trial
Bennett, G. G., Herring, S. J., Puleo, E., Stein, E. K., Emmons, K. M., & Gillman, M. W. (2010) · Obesity · doi:10.1038/oby.2009.242 · Cited by 202
“Our recruitment yield, though similar to comparable trials (28,32), was likely influenced by the requirement that participants have regular web access.”
ResultSalt and hypertension: is salt dietary reduction worth the effort?
Frisoli, T. M., Schmieder, R. E., Grodzicki, T., & Messerli, F. H. (2012) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.10.023 · Cited by 200
Graudal, N. A., Hubeck-Graudal, T., & Jurgens, G. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004022.pub3 · Cited by 170
Trends in 24-h urinary sodium excretion in the United States, 1957–2003: a systematic review
Bernstein, A. M., & Willett, W. C. (2010) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29367 · Cited by 166
Slawson, D. L., Fitzgerald, N., & Morgan, K. T. (2013) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2013.05.005 · Cited by 153
ASH Position Paper: Dietary Approaches to Lower Blood Pressure
Appel, L. J., & on Behalf of the American Society of Hypertension Writing Group (2009) · The Journal of Clinical Hypertension · doi:10.1111/j.1751-7176.2009.00136.x · Cited by 109
Self-citationRestrictive diets in the elderly: Never say never again?
Darmon, P., Kaiser, M. J., Bauer, J. M., Sieber, C. C., & Pichard, C. (2010) · Clinical Nutrition · doi:10.1016/j.clnu.2009.11.002 · Cited by 71
ASH position paper: Dietary approaches to lower blood pressure
Appel, L. J. (2009) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2009.08.003 · Cited by 67
Self-citationMeditation and blood pressure: a meta-analysis of randomized clinical trials
Shi, L., Zhang, D., Wang, L., Zhuang, J., Cook, R., & Chen, L. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001217 · Cited by 62
At the Tipping Point: Accomplishing Population‐Wide Sodium Reduction in the United States
Appel, L. J. (2008) · The Journal of Clinical Hypertension · doi:10.1111/j.1524-6175.2007.07227.x · Cited by 23
Self-citation
Metadata
- Authors
- Appel, L. J., Espeland, M. A., Easter, L., Wilson, A. C., Folmar, S., & Lacy, C. R.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2001-03-12
- Volume
- 161
- Issue
- 5
- Pages
- 685
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2126340672
- Cited by
- 273
- References
- 1
- FWCI
- 9.77
- Type
- journal article
- Language
- en
- Open access
- closed
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