Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons

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

doi:10.1001/jama.279.11.839

Cited by 1,057 publications

(215 citation statements)

References 38 publications

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“…Our findings are consistent with previous trials utilizing lifestyle interventions in subjects with specific risk factors or with known CVD 30, 31, 32, 33, 34, 35. However, these studies have not been performed in an otherwise relatively healthy population where the goal was not prevention of disease, but to maintain ideal health.…”

Section: Discussionsupporting

confidence: 91%

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Mheid

Kelli

et al. 2016

JAHA

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BackgroundLifestyle modifications are first‐line measures for cardiovascular disease prevention. Whether lifestyle intervention also preserves cardiovascular health is less clear. Our study examined the role of a Health Partner–administered lifestyle intervention on metrics of ideal cardiovascular health.Methods and ResultsA total of 711 university employees (48±11 years; 66% women, 72% Caucasian/22.5% African Americans) enrolled in a program that promoted healthier lifestyles at Emory University (Atlanta, GA). Anthropometric, laboratory, and physical activity measurements were performed at baseline and at 6 months, 1 year, and 2 years of follow‐up. Results were utilized by the Health Partner to generate a personalized plan aimed at meeting ideal health metrics. Compared to baseline, at each of the 6‐month, 1‐year, and 2‐year follow‐up visits, systolic blood pressure was lower by 3.6, 4.6, and 3.3 mm Hg (P<0.001), total cholesterol decreased by 5.3, 6.5, and 6.4 mg/dL (P<0.001), body mass index declined by 0.33, 0.45, and 0.38 kg/m2 (P<0.001), and the percentage of smokers decreased by 1.3%, 3.5%, and 3.5% (P<0.01), respectively. Changes were greater in those with greater abnormalities at baseline. Finally, the American Heart Association “Life's Simple 7” ideal cardiovascular health score increased by 0.28, 0.40, and 0.33 at 6 month, 1 year, and 2 years, respectively, compared to baseline visit.ConclusionsA personalized, goal‐directed Health Partner intervention significantly improved the cardiometabolic risk profile and metrics of cardiovascular health. These effects were evident at 6 months following enrollment and were sustained for 2 years. Whether the Health Partner intervention improves long‐term morbidity and mortality and is cost‐effective needs further investigation.

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Section: Discussionsupporting

confidence: 91%

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Mheid

Kelli

et al. 2016

JAHA

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“…Long-term high salt intake is an important risk factor for hypertension (5) . Several large randomised trials and meta-analyses of trials have shown that a reduction in salt intake lowers blood pressure in hypertensive individuals (6,29) . The climate in Napo County is like the south subtropics.…”

Section: Discussionmentioning

confidence: 99%

Association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations

Yin

et al. 2008

PHN

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Objective: To detect the association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations. Design: A cross-sectional study of hypertension. Setting: Both populations were from seven to nine villages in Napo County, Guangxi Zhuang Autonomous Region, China. Subjects: A total of 1068 subjects of Hei Yi Zhuang and 933 participants of Han Chinese aged 20-89 years were surveyed by a stratified randomised cluster sampling. Results: The levels of systolic blood pressure and pulse pressure were higher in Hei Yi Zhuang than in Han (125?20 (SD 18?62) v. 121?88 (SD 15?99) mmHg and 48?64 (SD 14?75) v. 44?98 (SD 11?12 ) mmHg, P , 0?001 for each, respectively). The prevalence of hypertension and isolated systolic hypertension was also higher in Hei Yi Zhuang than in Han (25?19 % v. 17?26 % and 12?45 % v. 3?86 %, P , 0?001 for each, respectively). Mean arterial pressure was positively correlated with gender, age, physical activity, TAG, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Hei Yi Zhuang (P , 0?05-0?001), whereas it was positively associated with gender, age, physical activity, BMI, waist circumference, total cholesterol, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Han (P , 0?05-0?001). Conclusions: The differences in blood pressure levels and the prevalence of hypertension between the Hei Yi Zhuang and Han populations were associated with different dietary habits, lifestyle choices, education level, as well as geographical surroundings.

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“…These associations were independent of age, socioeconomic status and other major risk factors for hypertension. Numerous epidemiologic studies [1][2][3][4][5][6]12,13,[21][22][23][24] and interventional trials [25][26][27][28] have demonstrated that weight change and excess weight plays a major role in determining BP levels, particularly among individuals with high BP. Few studies have evaluated the impact of weight and weight change on BP in normotensive individuals.…”

Section: Discussionmentioning

confidence: 99%

Body weight and weight change in relation to blood pressure in normotensive men

Yang

Wang

et al. 2006

J Hum Hypertens

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We examined blood pressure (BP) in association with weight change since age 20, body mass index (BMI) at different ages and fat distribution in normotensive individuals using baseline survey data collected in the Shanghai Men's Health Study, an ongoing populationbased prospective cohort study of Chinese men aged 40-74 years. All anthropometric and BP measurements were performed by medical professionals. Included in this analysis were 25 619 men who had no prior history of hypertension, diabetes or cardiovascular disease, never took any antihypertensive medication and had both normal systolic BP (SBP) and diastolic BP (DBP) (o140/90 mm Hg). Both SBP and DBP increased linearly across the whole range of weight gain since age 20. The adjusted mean differences between the highest and the lowest quintiles of weight gain were 6.0 mm Hg (95% confidence interval (CI): 5.6, 6.5) for SBP and 3.9 (95% CI: 3.6, 4.2) for DBP. When accounting for BMI at age 20, the multivariate-adjusted odds ratio of prehypertension (SBP, 120-139 and/or DBP, 80-89 mm Hg) was 4.1 (95% CI: 3.7, 4.5; P for trend o0.0001) comparing the extreme quintiles of weight gain. Similar positive associations were also observed for BMI at age 40, current BMI, circumferences of the waist and hips and waist-to-hip ratio. In conclusion, these data suggest that weight gain since age 20 and elevated adiposity may contribute significantly to the rise in BP in normotensive individuals, emphasizing the importance of weight control throughout adulthood in preventing high BP.

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Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons

Cited by 1,057 publications

References 38 publications

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations

Body weight and weight change in relation to blood pressure in normotensive men

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