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Volume 344:3-10 January 4, 2001 Number 1 Next

	Full Text PDF Editorial by Greenland, P. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The effect of dietary composition on blood pressure is a subject of public health importance. We studied the effect of different levels of dietary sodium, in conjunction with the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in vegetables, fruits, and low-fat dairy products, in persons with and in those without hypertension.

Methods A total of 412 participants were randomly assigned to eat either a control diet typical of intake in the United States or the DASH diet. Within the assigned diet, participants ate foods with high, intermediate, and low levels of sodium for 30 consecutive days each, in random order.

Results Reducing the sodium intake from the high to the intermediate level reduced the systolic blood pressure by 2.1 mm Hg (P<0.001) during the control diet and by 1.3 mm Hg (P=0.03) during the DASH diet. Reducing the sodium intake from the intermediate to the low level caused additional reductions of 4.6 mm Hg during the control diet (P<0.001) and 1.7 mm Hg during the DASH diet (P<0.01). The effects of sodium were observed in participants with and in those without hypertension, blacks and those of other races, and women and men. The DASH diet was associated with a significantly lower systolic blood pressure at each sodium level; and the difference was greater with high sodium levels than with low ones. As compared with the control diet with a high sodium level, the DASH diet with a low sodium level led to a mean systolic blood pressure that was 7.1 mm Hg lower in participants without hypertension, and 11.5 mm Hg lower in participants with hypertension.

Conclusions The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly. Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods.

Source Information

From the Endocrine–Hypertension Division and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.S., P.R.C.); the Duke Hypertension Center and the Sarah W. Stedman Center for Nutritional Studies, Duke University School of Medicine, Durham, N.C. (L.P.S., P.-H.L.); the Kaiser Permanente Center for Health Research, Portland, Oreg. (W.M.V., N.K.); the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore (L.J.A., E.R.M.); the Pennington Biomedical Research Center, Baton Rouge, La. (G.A.B., D.H.); and the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (E.O., D.G.S.-M.).

Other authors were Mikel Aickin, Ph.D., Kaiser Permanente Center for Health Research, Portland, Oreg.; Marlene M. Most-Windhauser, Ph.D., Pennington Biomedical Research Center, Baton Rouge, La.; Thomas J. Moore, M.D., Merck, West Point, Pa.; and Michael A. Proschan, Ph.D., and Jeffrey A. Cutler, M.D., National Heart, Lung, and Blood Institute, Bethesda, Md.

Address reprint requests to Dr. Sacks at the Nutrition Department, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at fsacks{at}hsph.harvard.edu.

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