• P K Whelton, L J Appel, M A Espeland, W B Applegate, W H Ettinger, J B Kostis, S Kumanyika, C R Lacy, K C Johnson, S Folmar, and J A Cutler.
• Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La 70112, USA. PWHELTON@TULANE.EDU
• JAMA. 1998 Mar 18; 279 (11): 839846839-46.

ContextNonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation.ObjectiveTo determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension.DesignRandomized controlled trial.ParticipantsA total of 975 [corrected] men and women aged 60 to 80 years with systolic blood pressure lower than 145 mm Hg and diastolic blood pressure lower than 85 mm Hg while receiving treatment with a single antihypertensive medication.SettingFour academic health centers.InterventionThe 585 obese participants were randomized to reduced sodium intake, weight loss, both, or usual care, and the 390 nonobese participants were randomized to reduced sodium intake or usual care. Withdrawal of antihypertensive medication was attempted after 3 months of intervention.Main Outcome MeasureDiagnosis of high blood pressure at 1 or more follow-up visits, or treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months).ResultsThe combined outcome measure was less frequent among those assigned vs not assigned to reduced sodium intake (relative hazard ratio, 0.69; 95% confidence interval [CI], 0.59-0.81; P<.001) and, in obese participants, among those assigned vs not assigned to weight loss (relative hazard ratio, 0.70; 95% CI, 0.57-0.87; P<.001). Relative to usual care, hazard ratios among the obese participants were 0.60 (95% CI, 0.45-0.80; P<.001) for reduced sodium intake alone, 0.64 (95% CI, 0.49-0.85; P=.002) for weight loss alone, and 0.47 (95% CI, 0.35-0.64; P<.001) for reduced sodium intake and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups.ConclusionReduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

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