Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Whelton, Paul K.; Appel, Lawrence J.; Espeland, Mark A.; Applegate, William B.; Ettinger, Jr, Walter H.; Kostis, John B.; Kumanyika, Shiriki; Lacy, Clifton R.; Johnson, Karen C.; Folmar, Steven; Cutler, Jeffrey A.; for the TONE Collaborative Research Group

doi:10.1001/jama.279.11.839

Cited by 1,200Sodium Intake and HealthBlood Pressure and Hypertension StudiesHormonal Regulation and Hypertension

Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Whelton, Paul K., Appel, Lawrence J., Espeland, Mark A., Applegate, William B., Ettinger, Jr, Walter H., Kostis, John B., Kumanyika, Shiriki, Lacy, Clifton R. +4 more·1998·JAMA

DOI 10.1001/jama.279.11.839

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Abstract

CONTEXT: Nonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation. OBJECTIVE: To determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension. DESIGN: Randomized controlled trial. PARTICIPANTS: A total of 975 [corrected] men and women aged 60 to 80 years with systolic blood pressure lower than 145 mm Hg and diastolic blood pressure lower than 85 mm Hg while receiving treatment with a single antihypertensive medication. SETTING: Four academic health centers. INTERVENTION: The 585 obese participants were randomized to reduced sodium intake, weight loss, both, or usual care, and the 390 nonobese participants were randomized to reduced sodium intake or usual care. Withdrawal of antihypertensive medication was attempted after 3 months of intervention. MAIN OUTCOME MEASURE: Diagnosis of high blood pressure at 1 or more follow-up visits, or treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months). RESULTS: The combined outcome measure was less frequent among those assigned vs not assigned to reduced sodium intake (relative hazard ratio, 0.69; 95% confidence interval [CI], 0.59-0.81; P<.001) and, in obese participants, among those assigned vs not assigned to weight loss (relative hazard ratio, 0.70; 95% CI, 0.57-0.87; P<.001). Relative to usual care, hazard ratios among the obese participants were 0.60 (95% CI, 0.45-0.80; P<.001) for reduced sodium intake alone, 0.64 (95% CI, 0.49-0.85; P=.002) for weight loss alone, and 0.47 (95% CI, 0.35-0.64; P<.001) for reduced sodium intake and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups. CONCLUSION: Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

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Because older adults have a high incidence of CVD events, even small improvements in risk factors should yield substantial benefit.
“Because of the high incidence of CVD events in older-aged individuals, even relatively small improvements in risk factors (eg, small reductions in BP and LDL cholesterol through diet and lifestyle changes) should be of substantial benefit.88,89”
From Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee (2006) · cites this paper as [89]

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Authors: Whelton, P. K., Appel, L. J., Espeland, M. A., Applegate, W. B., Ettinger, Jr., Kostis, J. B., Kumanyika, S., Lacy, C. R., Johnson, K. C., Folmar, S., Cutler, J. A., & for the TONE Collaborative Research Group
Affiliations: Tulane University (US)
Johns Hopkins University (US)
Wake Forest University (US)
University of Tennessee Health Science Center (US)
Pennsylvania State University (US)
Rutgers, The State University of New Jersey (US)
National Institutes of Health (US)
ORCID: Espeland, Mark A.
Applegate, William B.
Kostis, John B.
Kumanyika, Shiriki
Johnson, Karen C.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 1998-03-18
Volume: 279
Issue: 11
Pages: 839
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.279.11.839
OpenAlex: W2124529018
Cited by: 1,200
References: 38
Citations by year: 2026: 13 · 2025: 13 · 2024: 27 · 2023: 35 · 2022: 27 · 2021: 30 · 2020: 34 · 2019: 38 · 2018: 35 · 2017: 38 · 2016: 37 · 2015: 51 · 2014: 40 · 2013: 67 · 2012: 48
FWCI: 52.57
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (1r01ag009799-01a1, 5r01ag009771-04, 1r01hl048642-01)
National Institute on Aging (R01 AG-09771, R01 AG-09799)
National Heart, Lung, and Blood Institute (R01 HL-48642)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords: hypertension, older adults, sodium reduction, weight loss, non-pharmacological treatment, obesity, antihypertensive medication withdrawal, cardiovascular events, blood pressure control, lifestyle intervention, cardiovascular risk reduction, antihypertensive therapy
MeSH terms: Aged, Algorithms, Analysis of Variance, Antihypertensive Agents, Diet, Sodium-Restricted, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Obesity, Sodium, Dietary, Substance Withdrawal Syndrome, Weight Loss, Likelihood Functions, Proportional Hazards Models, Survival Analysis

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Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE)

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