Effects of Diet and Sodium Intake on Blood Pressure: Subgroup Analysis of the DASH-Sodium Trial

  1. William M. Vollmer, PhD;
  2. Frank M. Sacks, MD;
  3. Jamy Ard, MD;
  4. Lawrence J. Appel, MD;
  5. George A. Bray, MD;
  6. Denise G. Simons-Morton, MD, PhD;
  7. Paul R. Conlin, MD;
  8. Laura P. Svetkey, MD;
  9. Thomas P. Erlinger, MD;
  10. Thomas J. Moore, MD;
  11. Njeri Karanja, PhD; and
  12. for the DASH-Sodium Trial Collaborative Research Group
  1. From the Center for Health Research, Portland, Oregon; Brigham and Women's Hospital and Boston University Medical Center, Boston, Massachusetts; Duke University Medical Center, Durham, North Carolina; Johns Hopkins University, Baltimore, and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and Pennington Biomedical Research Center, Baton Rouge, Louisiana.

    Abstract

    Background: Initial findings from the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial demonstrated that reduction of sodium intake in two different diets decreased blood pressure in participants with and without hypertension.

    Objective: To determine effects on blood pressure of reduced sodium intake and the DASH diet in additional subgroups.

    Design: Randomized feeding study.

    Setting: Four clinical centers and a coordinating center.

    Participants: 412 adults with untreated systolic blood pressure of 120 to 160 mm Hg and diastolic blood pressure of 80 to 95 mm Hg.

    Intervention: Participants followed the DASH diet or a control (typical U.S.) diet for three consecutive 30-day feeding periods, during which sodium intake (50, 100, and 150 mmol/d at 2100 kcal) varied according to a randomly assigned sequence. Body weight was maintained.

    Measurements: Systolic and diastolic blood pressure.

    Results: In all subgroups, the DASH diet and reduced sodium intake were each associated with significant decreases in blood pressure; these two factors combined produced the greatest reductions. Among nonhypertensive participants who received the control diet, lower (vs. higher) sodium intake decreased blood pressure by 7.0/3.8 mm Hg in those older than 45 years of age (P < 0.001) and by 3.7/1.5 mm Hg in those 45 years of age or younger (P < 0.05).

    Conclusion: The DASH diet plus reduced sodium intake is recommended to control blood pressure in diverse subgroups.

    Article and Author Information

    • * For participants in the DASH-Sodium Trial Collaborative Research Group, see the Appendix.

    • Acknowledgments: The authors thank the trial participants for their sustained commitment to the DASH-Sodium Trial; the external Protocol Review Committee (Jeremiah Stamler, MD [Chair], Jackson T. Wright, MD, PhD, Lemuel A. Moye, MD, PhD, Janice A. Derr, PhD, and Richard D. Mattes, PhD); and the Data and Safety Monitoring Board (Richard Grimm, MD [Chair], Jeremiah Stamler, MD, Jackson T. Wright, MD, PhD, Avital Cnaan, PhD, Janice A. Derr, PhD, and Richard D. Mattes, PhD). They also thank the companies that donated food: Almond Board of California, Beatrice Foods, Best Foods, Cabot Creamery, Curtis Burns Foods, Dannon Company, Diamond Crystal Specialty Foods, Elwood International, Hershey Foods Corp., Hormel Foods, Kellogg Company, Lipton Co., McCormick Spice Co., Nabisco Foods, Proctor & Gamble Co., Quaker Oats Co., and Sunmaid Growers, and Frost Cold Storage for food storage.

    • Grant Support: By a cooperative agreement and other awards from the National Heart, Lung, and Blood Institute, National Institutes of Health, to Brigham and Women's Hospital (U01-HL 57173), Duke University (U01-HL57114), Pennington Biomedical Research Institute (U01-HL57190), Johns Hopkins University (U01-HL57139 and K08 HL03857-01), and Kaiser Permanente Center for Health Research (U01-HL57156), and from the General Clinical Research Center Program of the National Center for Research Resources, National Institutes of Health, to Brigham and Women's Hospital (M01-RR02635) and Johns Hopkins University (M01-RR00722).

    • Requests for Single Reprints: William M. Vollmer, PhD, Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227-1110; e-mail, william.vollmer{at}kpchr.org.

    • Current Author Addresses: Drs. Vollmer and Karanja: Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

    • Drs. Sacks and Conlin: Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.

    • Drs. Ard and Svetkey: Duke University Medical Center, 3020 Pickett Road, Durham. NC 27705.

    • Drs. Appel and Erlinger: Johns Hopkins University, 2024 East Monument Street, Suite 2-602, Baltimore, MD 21205.

    • Dr. Bray: Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808.

    • Dr. Simons-Morton: National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892.

    • Dr. Moore: Boston University School of Medicine, 715 Albany Street, Boston, MA 02118.

    • Author Contributions: Conception and design: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

    • Analysis and interpretation of the data: W.M. Vollmer, J. Ard, L.J. Appel, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

    • Drafting of the article: W.M. Vollmer, F.M. Sacks, J. Ard, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

    • Critical revision of the article for important intellectual content: W.M. Vollmer, F.M. Sacks, J. Ard, L.J. Appel, G.A. Bray, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.P. Erlinger, T.J. Moore.

    • Final approval of the article: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.P. Erlinger, T.J. Moore.

    • Provision of study materials or patients: F.M. Sacks, L.J. Appel, P.R. Conlin, L.P. Svetkey.

    • Statistical expertise: W.M. Vollmer.

    • Obtaining of funding: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, L.P. Svetkey, T.J. Moore, N. Karanja.

    • Administrative, technical, or logistic support: W.M. Vollmer, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja

    • Collection and assembly of data: W.M. Vollmer, L.J. Appel, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

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    1. Ann Intern Med December 18, 2001 vol. 135 no. 12 1019-1028
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