Reduced sodium intake significantly decreased the occurrence of elevated blood pressure, medication resumption, or cardiovascular events compared to control (59% vs 73%; HR 0.68, P<0.001).
RCT (n=681)
randomly assigned
Does reduced sodium intake improve hypertension control and prevent the need for medication resumption in older individuals?
Reduced sodium intake is an effective nonpharmacologic therapy that significantly improves hypertension control and reduces the need for antihypertensive medication in older adults.
Effect estimate: HR 0.68
Absolute Event Rate: 59% vs 73%
p-value: p=<.001
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 Three months after the start of intervention, medication was withdrawn.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.
Appel et al. (Mon,) conducted a rct in hypertension (n=681). reduced sodium intervention vs. control was evaluated on 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 (HR 0.68, p=<.001). Reduced sodium intake significantly decreased the occurrence of elevated blood pressure, medication resumption, or cardiovascular events compared to control (59% vs 73%; HR 0.68, P<0.001).
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