A factorial study of salt restriction and a low-fat/high-fibre diet in hypertensive subjects

OBJECTIVE: To compare the independent and additive effects of sodium restriction and a low-fat, high polyunsaturated: saturated fatty acids (P:S) ratio, high-fibre diet upon blood pressure. DESIGN: A randomized, parallet, double-blind, placebo-controlled (for sodium) 2 x 2 factorial trial. SETTING: Clinical. PARTICIPANTS: Ninety-five hypertensive subjects (mean blood pressure, 137/83 mmHg), mean age 53.5 years, consuming less than 30 ml ethanol/day were selected from community volunteers. Seventy-nine treated and twelve untreated hypertensives completed the trial. INTERVENTION: Subjects followed either a low-sodium, low-fat/high-fibre diet (less than 60 mmol sodium/day; 30% fat energy; P:S ratio = 1; 30-50 g fibre/day) or a low-sodium, normal-fat/normal-fibre diet (less than 60 mmol sodium/day; 40% fat energy; P:S ratio = 0.3; 15 g fibre/day) for 8 weeks. Half of each group received 100 mmol/day NaCl and the remainder received placebo. MAIN OUTCOME MEASURES: Blood pressure and blood lipids. RESULTS: Sodium restriction significantly reduced standing and supine systolic blood pressure, with no effect upon diastolic blood pressure. The low-fat/high-fibre diet had no effect upon blood pressure, but significantly reduced total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. CONCLUSIONS: Sodium restriction reduced blood pressure and did not raise low-density lipoprotein cholesterol. A low-fat/high-fibre diet did not reduce blood pressure but lowered cholesterol levels. A combination of the two regimes has the greater potential for reducing cardiovascular risk in hypertensives.