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The Hypertension Prevention Trial: Three-Year Effects of Dietary Changes on Blood Pressure

The Hypertension Prevention Trial: Three-Year Effects of Dietary Changes on Blood Pressure Abstract • A total of 841 healthy men and women aged 25 to 49 years, with diastolic blood pressures of 78 to 89 mm Hg, were randomly assigned to a control treatment group (no dietary counseling) or to one of four dietary counseling treatment groups (reduced calories, reduced sodium, reduced sodium and calories, or reduced sodium and increased potassium). Participants were followed for a 3-year period to assess the effect of dietary changes on blood pressure. After 6 months, counseling had resulted in a net (of control) mean overnight urinary sodium reduction of 13%, a potassium increase of 8%, and a decrease in mean body weight of 7%. At 3 years, the sodium and weight reductions were 10% and 4%, respectively; the potassium change was nil. All four dietary counseling treatment groups had lower mean blood pressures than the control group. The largest net reduction in blood pressure occurred in the calorie group: diastolic pressure was 2.8 mm Hg and 1.8 mm Hg and systolic pressure, 5.1 mm Hg and 2.4 mm Hg at 6 months and 3 years, respectively. All four dietary counseling treatment groups experienced fewer hypertensive events; significantly fewer occurred in the sodium groups. The beneficial effects on blood pressure achieved in this trial have implications for the prevention of cardiovascular disease through dietary reduction of calories and sodium. (Arch Intern Med. 1990;150:153-162) References 1. Lenfant C, Roccella EJ. Trends in hypertension control in the United States . Chest . 1984;86:459-462.Crossref 2. Kannel WB, Doyle JT, Ostfeld AM, et al. Optimal resources for pursuing prevention of atherosclerotic disease . Circulation . 1984;70:157A-205A.Crossref 3. Kannel WB. On the cardiovascular hazards of hypertension . In: Onesti G, Klimt CR, eds. Hypertension: Determinants, Complications and Intervention . New York, NY: Grune & Stratton Inc; 1979:143-149. 4. Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final Report of the Pooling Project . J Chronic Dis . 1978;31:201-306.Crossref 5. Kaplan NM. Nonpharmacologic therapy of hypertension . Med Clin North Am . 1987;71:921-933. 6. Subcommittee on Nonpharmacological Therapy of the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Final report: nonpharmacological approaches to the control of high blood pressure . Hypertension . 1986;8:444-467.Crossref 7. Ashley FW Jr, Kannel WB. Relation of weight change to changes in atherogenic traits: the Framingham Study . J Chronic Dis . 1974;27:103-114.Crossref 8. Oberman A, Lane NE, Harlan WR, Graybiel A, Mitchell R. Trends in systolic pressure in the thousand aviator cohort over a 24-year period . Circulation . 1967;36:812-821.Crossref 9. Prineas RJ, Blackburn H. Clinical and epidemiologic relationships between electrolytes and hypertension: dietary electrolytes in hypertension . In: Horan MJ, Blaustein M, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension . New York, NY: Biomedical Information Corp; 1985:63-85. 10. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24-hour urinary sodium and potassium excretion . Br Med J . 1988;297:319-328.Crossref 11. MacMahon S, Cutler J, Brittain E, Higgins M. Obesity and hypertension: epidemiological and clinical issues . Eur Heart J . 1987;8( (suppl B) ):57-70.Crossref 12. Meinert CL, Tonascia J, Tonascia S, eds. The Hypertension Prevention Trial: design, methods, and baseline results . Controlled Clin Trials . 1989;10( (suppl) ):1S-117S.Crossref 13. Florey CV. The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies . J Chronic Dis . 1970;23:93-103.Crossref 14. Meinert CL, Borhani NO, Langford HG, for the Hypertension Prevention Trial Research Group. Design, methods and rationale in the Hypertension Prevention Trial . Controlled Clin Trials . 1989;10( (suppl) ):1S-29S.Crossref 15. Metropolitan Life Insurance Company. Trends in average weights and heights among insured men and women . Statist Bull . 1977;58:1-6. 16. Kingsley RG, Wilson GT. Behavior therapy for obesity: a comparative investigation of long-term efficacy . J Consult Clin Psychol . 1977;45:288-298.Crossref 17. Jeffery RW, Tonascia S, Bjornson-Benson W, Schlundt DG, Sugars C, for the Hypertension Prevention Trial Research Group. Treatment in the Hypertension Prevention Trial . Controlled Clin Trials . 1989;10( (suppl) ):65S-83S.Crossref 18. TonasciaJ, Donithan M, Tonascia S, Hiller J, Hall WD, Langford HG, for the Hypertension Prevention Trial Research Group. Hypertension Prevention Trial: estimation of 24-hour sodium and potassium excretion from overnight urine collections . Baltimore, Md: Department of Biostatistics, The Johns Hopkins University; 1989. Technical Report 703. 19. Hypertension Detection and Follow-up Program Cooperative Group. Variability of blood pressure and the results of screening in the Hypertension Detection and Follow-up Program . J Chronic Dis . 1978;31:651-667.Crossref 20. Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA . 1982;248:1465-1477.Crossref 21. Hoaglin DC, Mosteller F, Tukey JW, eds. Understanding Robust and Exploratory Data Analysis . New York, NY: John Wiley & Sons Inc; 1983. 22. Huber PJ. Robust Statistics . New York, NY: John Wiley & Sons Inc; 1981. 23. Conover WJ, Inman RL. Rank transformations as a bridge between parametric and nonparametric statistics . Am Statistician . 1981;35:124-129. 24. Cox DR. Regression models and life tables . J R Statist Soc . 1972;34 (series B):187-220. 25. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes . Biometrics . 1986;42:121-130.Crossref 26. Fregly MJ. Attempts to estimate sodium intake in humans . In: Horan MJ, Blaustein M, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension . New York, NY: Biomedical Information Corp; 1985:93-112. 27. Haynes RB, Harper AC, Costley SR, et al. Failure of weight reduction to reduce mildly elevated blood pressure: a randomized trial . J Hypertension . 1984;2:535-539.Crossref 28. Heyden S. The workingman's diet, II: effect of weight reduction in obese patients with hypertension, diabetes, hyperuricemia and hyperlipidemia . Nutr Metab . 1978;22:141-159.Crossref 29. MacMahon SW, Macdonald GJ, Bernstein L, Andrews G, Blacket RB. Comparison of weight reduction with metoprolol in treatment of hypertension in young overweight patients . Lancet . 1985;1:1233-1236.Crossref 30. Ramsay LE, Ramsay MH, Hettiarachchi J, Davies DL, Winchester J. Weight reduction in a blood pressure clinic . Br Med J . 1978;2:244-245.Crossref 31. Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B. Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients . N Engl J Med . 1978;298:1-6.Crossref 32. Cohen N, Flamenbaum W. Obesity and hypertension: demonstration of a 'floor effect.' Am J Med . 1986;80:177-181.Crossref 33. Grobbee DE, Hofman A. Does sodium restriction lower blood pressure? Br Med J . 1986;293:27-29.Crossref 34. Cutler J, MacMahon S, Wilhelmsen L, Bailey K, Furberg C. Randomized clinical trials of sodium reduction: effects on blood pressure in hypertensives and normotensives . J Hypertension . 1986;4( (suppl 6) ):S699.Crossref 35. Holly JMP, Goodwin FJ, Evans SJW, Vandenburg MJ, Ledingham JM. Re-analysis of data in two Lancet papers on the effect of dietary sodium and potassium on blood pressure . Lancet . 1981;2:1384-1387.Crossref 36. Skrabal F, Aubock J, Hortnagl H. Low sodium/high potassium diet for prevention of hypertension: probable mechanisms of action . Lancet . 1981; 2:895-900.Crossref 37. Smith SJ, Markandu ND, Sagnella GA, MacGregor GA. Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction? Br Med J . 1985;290:110-113.Crossref 38. Gordon T, Sorlie P, Kannel WB. Problems in the assessment of blood pressure: the Framingham study . Int J Epidemiol . 1976;5:327-334.Crossref 39. Puska P, Iacono JM, Nissinen A, et al. Controlled, randomised trial of the effect of dietary fat on blood pressure . Lancet . 1983;1:1-5.Crossref 40. Stamler R, Stamler J, Gosch FC, et al. Primary prevention of hypertension by nutritional-hygienic means: final report of a randomized, controlled trial . JAMA . 1989;262:1801-1807.Crossref 41. Stamler R, Stamler J, Gosch FC, McDonald AM. Primary prevention of hypertension: a randomized controlled trial . Ann Clin Res . 1984;43( (suppl) ): 136-142. 42. National Center for Health Statistics. Blood Pressure Levels in Persons 18-74 Years of Age in 1976-80 and Trends in Blood Pressure from 1960 to 1980 in the United States: Data from the National Health Survey . Washington, DC: Vital and Health Statistics, Public Health Service; July 1986. Department of Health and Human Services publication (PHS) 86-1684. Series 11, No. (234) . 43. MacMahon SW, Cutler JA, Neaton JD, et al, for the Multiple Risk Factor Intervention Trial Research Group. Relationship of blood pressure to coronary and stroke morbidity and mortality in clinical trials and epidemiological studies . J Hypertension . 1986;4( (suppl 6) ):514-516. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Hypertension Prevention Trial: Three-Year Effects of Dietary Changes on Blood Pressure

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References (42)

Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390130131021
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Abstract

Abstract • A total of 841 healthy men and women aged 25 to 49 years, with diastolic blood pressures of 78 to 89 mm Hg, were randomly assigned to a control treatment group (no dietary counseling) or to one of four dietary counseling treatment groups (reduced calories, reduced sodium, reduced sodium and calories, or reduced sodium and increased potassium). Participants were followed for a 3-year period to assess the effect of dietary changes on blood pressure. After 6 months, counseling had resulted in a net (of control) mean overnight urinary sodium reduction of 13%, a potassium increase of 8%, and a decrease in mean body weight of 7%. At 3 years, the sodium and weight reductions were 10% and 4%, respectively; the potassium change was nil. All four dietary counseling treatment groups had lower mean blood pressures than the control group. The largest net reduction in blood pressure occurred in the calorie group: diastolic pressure was 2.8 mm Hg and 1.8 mm Hg and systolic pressure, 5.1 mm Hg and 2.4 mm Hg at 6 months and 3 years, respectively. All four dietary counseling treatment groups experienced fewer hypertensive events; significantly fewer occurred in the sodium groups. The beneficial effects on blood pressure achieved in this trial have implications for the prevention of cardiovascular disease through dietary reduction of calories and sodium. (Arch Intern Med. 1990;150:153-162) References 1. Lenfant C, Roccella EJ. Trends in hypertension control in the United States . Chest . 1984;86:459-462.Crossref 2. Kannel WB, Doyle JT, Ostfeld AM, et al. Optimal resources for pursuing prevention of atherosclerotic disease . Circulation . 1984;70:157A-205A.Crossref 3. Kannel WB. On the cardiovascular hazards of hypertension . In: Onesti G, Klimt CR, eds. Hypertension: Determinants, Complications and Intervention . New York, NY: Grune & Stratton Inc; 1979:143-149. 4. Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final Report of the Pooling Project . J Chronic Dis . 1978;31:201-306.Crossref 5. Kaplan NM. Nonpharmacologic therapy of hypertension . Med Clin North Am . 1987;71:921-933. 6. Subcommittee on Nonpharmacological Therapy of the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Final report: nonpharmacological approaches to the control of high blood pressure . Hypertension . 1986;8:444-467.Crossref 7. Ashley FW Jr, Kannel WB. Relation of weight change to changes in atherogenic traits: the Framingham Study . J Chronic Dis . 1974;27:103-114.Crossref 8. Oberman A, Lane NE, Harlan WR, Graybiel A, Mitchell R. Trends in systolic pressure in the thousand aviator cohort over a 24-year period . Circulation . 1967;36:812-821.Crossref 9. Prineas RJ, Blackburn H. Clinical and epidemiologic relationships between electrolytes and hypertension: dietary electrolytes in hypertension . In: Horan MJ, Blaustein M, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension . New York, NY: Biomedical Information Corp; 1985:63-85. 10. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24-hour urinary sodium and potassium excretion . Br Med J . 1988;297:319-328.Crossref 11. MacMahon S, Cutler J, Brittain E, Higgins M. Obesity and hypertension: epidemiological and clinical issues . Eur Heart J . 1987;8( (suppl B) ):57-70.Crossref 12. Meinert CL, Tonascia J, Tonascia S, eds. The Hypertension Prevention Trial: design, methods, and baseline results . Controlled Clin Trials . 1989;10( (suppl) ):1S-117S.Crossref 13. Florey CV. The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies . J Chronic Dis . 1970;23:93-103.Crossref 14. Meinert CL, Borhani NO, Langford HG, for the Hypertension Prevention Trial Research Group. Design, methods and rationale in the Hypertension Prevention Trial . Controlled Clin Trials . 1989;10( (suppl) ):1S-29S.Crossref 15. Metropolitan Life Insurance Company. Trends in average weights and heights among insured men and women . Statist Bull . 1977;58:1-6. 16. Kingsley RG, Wilson GT. Behavior therapy for obesity: a comparative investigation of long-term efficacy . J Consult Clin Psychol . 1977;45:288-298.Crossref 17. Jeffery RW, Tonascia S, Bjornson-Benson W, Schlundt DG, Sugars C, for the Hypertension Prevention Trial Research Group. Treatment in the Hypertension Prevention Trial . Controlled Clin Trials . 1989;10( (suppl) ):65S-83S.Crossref 18. TonasciaJ, Donithan M, Tonascia S, Hiller J, Hall WD, Langford HG, for the Hypertension Prevention Trial Research Group. Hypertension Prevention Trial: estimation of 24-hour sodium and potassium excretion from overnight urine collections . Baltimore, Md: Department of Biostatistics, The Johns Hopkins University; 1989. Technical Report 703. 19. Hypertension Detection and Follow-up Program Cooperative Group. Variability of blood pressure and the results of screening in the Hypertension Detection and Follow-up Program . J Chronic Dis . 1978;31:651-667.Crossref 20. Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA . 1982;248:1465-1477.Crossref 21. Hoaglin DC, Mosteller F, Tukey JW, eds. Understanding Robust and Exploratory Data Analysis . New York, NY: John Wiley & Sons Inc; 1983. 22. Huber PJ. Robust Statistics . New York, NY: John Wiley & Sons Inc; 1981. 23. Conover WJ, Inman RL. Rank transformations as a bridge between parametric and nonparametric statistics . Am Statistician . 1981;35:124-129. 24. Cox DR. Regression models and life tables . J R Statist Soc . 1972;34 (series B):187-220. 25. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes . Biometrics . 1986;42:121-130.Crossref 26. Fregly MJ. Attempts to estimate sodium intake in humans . In: Horan MJ, Blaustein M, Dunbar JB, Kachadorian W, Kaplan NM, Simopoulos AP, eds. NIH Workshop on Nutrition and Hypertension . New York, NY: Biomedical Information Corp; 1985:93-112. 27. Haynes RB, Harper AC, Costley SR, et al. Failure of weight reduction to reduce mildly elevated blood pressure: a randomized trial . J Hypertension . 1984;2:535-539.Crossref 28. Heyden S. The workingman's diet, II: effect of weight reduction in obese patients with hypertension, diabetes, hyperuricemia and hyperlipidemia . Nutr Metab . 1978;22:141-159.Crossref 29. MacMahon SW, Macdonald GJ, Bernstein L, Andrews G, Blacket RB. Comparison of weight reduction with metoprolol in treatment of hypertension in young overweight patients . Lancet . 1985;1:1233-1236.Crossref 30. Ramsay LE, Ramsay MH, Hettiarachchi J, Davies DL, Winchester J. Weight reduction in a blood pressure clinic . Br Med J . 1978;2:244-245.Crossref 31. Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B. Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients . N Engl J Med . 1978;298:1-6.Crossref 32. Cohen N, Flamenbaum W. Obesity and hypertension: demonstration of a 'floor effect.' Am J Med . 1986;80:177-181.Crossref 33. Grobbee DE, Hofman A. Does sodium restriction lower blood pressure? Br Med J . 1986;293:27-29.Crossref 34. Cutler J, MacMahon S, Wilhelmsen L, Bailey K, Furberg C. Randomized clinical trials of sodium reduction: effects on blood pressure in hypertensives and normotensives . J Hypertension . 1986;4( (suppl 6) ):S699.Crossref 35. Holly JMP, Goodwin FJ, Evans SJW, Vandenburg MJ, Ledingham JM. Re-analysis of data in two Lancet papers on the effect of dietary sodium and potassium on blood pressure . Lancet . 1981;2:1384-1387.Crossref 36. Skrabal F, Aubock J, Hortnagl H. Low sodium/high potassium diet for prevention of hypertension: probable mechanisms of action . Lancet . 1981; 2:895-900.Crossref 37. Smith SJ, Markandu ND, Sagnella GA, MacGregor GA. Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction? Br Med J . 1985;290:110-113.Crossref 38. Gordon T, Sorlie P, Kannel WB. Problems in the assessment of blood pressure: the Framingham study . Int J Epidemiol . 1976;5:327-334.Crossref 39. Puska P, Iacono JM, Nissinen A, et al. Controlled, randomised trial of the effect of dietary fat on blood pressure . Lancet . 1983;1:1-5.Crossref 40. Stamler R, Stamler J, Gosch FC, et al. Primary prevention of hypertension by nutritional-hygienic means: final report of a randomized, controlled trial . JAMA . 1989;262:1801-1807.Crossref 41. Stamler R, Stamler J, Gosch FC, McDonald AM. Primary prevention of hypertension: a randomized controlled trial . Ann Clin Res . 1984;43( (suppl) ): 136-142. 42. National Center for Health Statistics. Blood Pressure Levels in Persons 18-74 Years of Age in 1976-80 and Trends in Blood Pressure from 1960 to 1980 in the United States: Data from the National Health Survey . Washington, DC: Vital and Health Statistics, Public Health Service; July 1986. Department of Health and Human Services publication (PHS) 86-1684. Series 11, No. (234) . 43. MacMahon SW, Cutler JA, Neaton JD, et al, for the Multiple Risk Factor Intervention Trial Research Group. Relationship of blood pressure to coronary and stroke morbidity and mortality in clinical trials and epidemiological studies . J Hypertension . 1986;4( (suppl 6) ):514-516.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1990

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