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ARTICLE |

Dietary Sodium Restriction as Adjunctive Treatment of Hypertension FREE

Myron H. Weinberger, MD; Stuart J. Cohen, EdD; Judy Z. Miller, PhD; Friedrich C. Luft, MD; Clarence E. Grim, MD; Naomi S. Fineberg, PhD
[+] Author Affiliations

Reprint requests to Hypertension Research Center, Department of Medicine, Indiana University School of Medicine, 541 Clinical Dr, Room 409, Indianapolis, IN 46223 (Dr Weinberger).


JAMA. 1988;259(17):2561-2565. doi:10.1001/jama.1988.03720170037030
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To examine the effect of modest dietary sodium ion restriction in treated hypertensive individuals, we studied 114 hypertensive patients undergoing individualized dietary counseling with a research dietitian to achieve reduction in dietary sodium ion intake. A significant reduction in mean sodium ion intake was achieved after the first of three lessons and was maintained for 30 weeks with no change in potassium ion intake. Significant falls in blood pressure and body weight were observed with no significant correlations noted between the two variables, implying independence of these effects. Individuals compliant with the dietary sodium ion restriction goal (urinary excretion, ≤80 mmol/d [≤80 mEq/24 h]) were more likely to have a reduction in number of medications than those not reaching that goal. Ninety-eight of the 114 patients completed the entire 30 weeks. Patients who dropped out tended to have lower diastolic blood pressures and required fewer medications for blood pressure control than those who completed the 30 weeks. For these reasons, patients in the former group may have been less highly motivated to complete the study. These observations suggest that modest dietary sodium ion restriction is feasible in treated hypertensive patients and that adherence to such a regimen may permit blood pressure control with fewer medications.

(JAMA 1988;259:2561-2565)

REFERENCES

Kempner W:  Treatment of hypertensive vascular disease with rice diet. Am J Med 1948;;4:545-577.
Weinberger MH:  Antihypertensive therapy and lipids: Paradoxical influences on cardiovascular disease risk. Am J Med 1986;;80( (suppl) ):64-70.
Kaplan NM:  Non-drug treatment of hypertension. Ann Intern Med 1985;;102:359-373.
Parijs J, Joossens JV, Van der Linden L, et al:  Moderate sodium restriction and diuretics in the treatment of hypertension. Am Heart J 1973;;85:22-34.
MacGregor GA, Markandu N, Best F, et al:  Double-blind, randomized, crossover trial of moderate sodium restriction in essential hypertension. Lancet 1982;;1:351-355.
Langford HG, Blaufox MD, Oberman A, et al:  Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985;;253:657-664.
Morgan T, Adams W, Gillies A, et al:  Hypertension treated by salt restriction. Lancet 1978;;1:227-230.
Beard TC, Cooke HM, Gray WR, et al:  Randomized, controlled trial of a no-added-sodium diet for mild hypertension. Lancet 1982;;2:455-458.
Grobbee DE, Hofman A:  Does sodium restriction lower blood pressure? Br Med J Clin Res 1986;;293:27-29.
Fujita T, Henry WL, Bartter FC, et al:  Factors influencing blood pressure in salt-sensitive patients with hypertension. Am J Med 1980;;69:334-344.
Weinberger MH, Miller JZ, Luft FC, et al:  Definitions and characteristics of sodium sensitivity and blood pressure resistance. Hypertension 1986;;8( (suppl 1) , pt 2):127-134.
Dustan HR, Tarazi RC, Bravo EL:  Diuretic and diet treatment of hypertension. Arch Intern Med 1974;;133:1007-1013.
Sullivan JM, Prewitt RL, Ratts TE, et al:  Hemodynamic characteristics of sodium-sensitive human subjects. Hypertension 1987;;9:398-406.
Lang CL, Weinberger MH, Miller JZ:  Dietary counseling results in effective dietary sodium restriction. J Am Diet Assoc 1985;;85:477-479.
Wallenstein S, Zucker CL, Fleiss JL:  Some statistical methods useful in circulation research. Circ Res 1980;;47:1-9.
Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973;,p 20.
MacGregor GA:  Sodium is more important than calcium in essential hypertension. Hypertension 1985;;7:628-637.
Medical Research Council Working Party on Mild-to-Moderate Hypertension:  Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet 1981;;2:539-543.
Amery A, Brixho P, Clement D, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1985;;1:1349-1354.
Multiple Risk Factor Intervention Trial Research Group:  Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982;;248:1465-1477.
Kuller LH, Hulley SB, Cohen JD, et al:  Unexpected effects of treating hypertension in men with electrocardiographic abnormalities: A critical analysis. Circulation 1986;;73:114-123.
Weinberger MH:  Antihypertensive therapy and lipids: Evidence, mechanisms, and implications. Arch Intern Med 1985;;145:1102-1105.
Lasser NL, Grandits G, Caggiula AW, et al:  Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial. Am J Med 1984;;76( (suppl) ):52-66.
Stamler R, Stamler J, Grimm R, et al:  Nutritional therapy for high blood pressure. JAMA 1987;;257:1484-1491.
Wassertheil-Smoller S, Blaufox MD, Langford HG, et al:  Prediction of response to sodium intervention for blood pressure control. J Hypertens Suppl 1986;;4 ( (suppl 5) ):343-346.

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Kempner W:  Treatment of hypertensive vascular disease with rice diet. Am J Med 1948;;4:545-577.
Weinberger MH:  Antihypertensive therapy and lipids: Paradoxical influences on cardiovascular disease risk. Am J Med 1986;;80( (suppl) ):64-70.
Kaplan NM:  Non-drug treatment of hypertension. Ann Intern Med 1985;;102:359-373.
Parijs J, Joossens JV, Van der Linden L, et al:  Moderate sodium restriction and diuretics in the treatment of hypertension. Am Heart J 1973;;85:22-34.
MacGregor GA, Markandu N, Best F, et al:  Double-blind, randomized, crossover trial of moderate sodium restriction in essential hypertension. Lancet 1982;;1:351-355.
Langford HG, Blaufox MD, Oberman A, et al:  Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985;;253:657-664.
Morgan T, Adams W, Gillies A, et al:  Hypertension treated by salt restriction. Lancet 1978;;1:227-230.
Beard TC, Cooke HM, Gray WR, et al:  Randomized, controlled trial of a no-added-sodium diet for mild hypertension. Lancet 1982;;2:455-458.
Grobbee DE, Hofman A:  Does sodium restriction lower blood pressure? Br Med J Clin Res 1986;;293:27-29.
Fujita T, Henry WL, Bartter FC, et al:  Factors influencing blood pressure in salt-sensitive patients with hypertension. Am J Med 1980;;69:334-344.
Weinberger MH, Miller JZ, Luft FC, et al:  Definitions and characteristics of sodium sensitivity and blood pressure resistance. Hypertension 1986;;8( (suppl 1) , pt 2):127-134.
Dustan HR, Tarazi RC, Bravo EL:  Diuretic and diet treatment of hypertension. Arch Intern Med 1974;;133:1007-1013.
Sullivan JM, Prewitt RL, Ratts TE, et al:  Hemodynamic characteristics of sodium-sensitive human subjects. Hypertension 1987;;9:398-406.
Lang CL, Weinberger MH, Miller JZ:  Dietary counseling results in effective dietary sodium restriction. J Am Diet Assoc 1985;;85:477-479.
Wallenstein S, Zucker CL, Fleiss JL:  Some statistical methods useful in circulation research. Circ Res 1980;;47:1-9.
Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973;,p 20.
MacGregor GA:  Sodium is more important than calcium in essential hypertension. Hypertension 1985;;7:628-637.
Medical Research Council Working Party on Mild-to-Moderate Hypertension:  Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet 1981;;2:539-543.
Amery A, Brixho P, Clement D, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1985;;1:1349-1354.
Multiple Risk Factor Intervention Trial Research Group:  Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982;;248:1465-1477.
Kuller LH, Hulley SB, Cohen JD, et al:  Unexpected effects of treating hypertension in men with electrocardiographic abnormalities: A critical analysis. Circulation 1986;;73:114-123.
Weinberger MH:  Antihypertensive therapy and lipids: Evidence, mechanisms, and implications. Arch Intern Med 1985;;145:1102-1105.
Lasser NL, Grandits G, Caggiula AW, et al:  Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial. Am J Med 1984;;76( (suppl) ):52-66.
Stamler R, Stamler J, Grimm R, et al:  Nutritional therapy for high blood pressure. JAMA 1987;;257:1484-1491.
Wassertheil-Smoller S, Blaufox MD, Langford HG, et al:  Prediction of response to sodium intervention for blood pressure control. J Hypertens Suppl 1986;;4 ( (suppl 5) ):343-346.
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