Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)
Identifieur interne : 000915 ( Istex/Corpus ); précédent : 000914; suivant : 000916Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)
Auteurs : Nancy R. Cook ; Jeffrey A. Cutler ; Eva Obarzanek ; Julie E. Buring ; Kathryn M. Rexrode ; Shiriki K. Kumanyika ; Lawrence J. Appel ; Paul K. WheltonSource :
- BMJ [ 0959-8138 ] ; 2007-04-28.
English descriptors
- Teeft :
- Additional adjustment, Antihypertensive medication, Arch intern, Baseline, Baseline characteristics, Baseline sodium excretion, Baseline weight, Blood institute, Blood pressure, Blood pressure levels, Cardiovascular, Cardiovascular cause, Cardiovascular disease, Cardiovascular event, Cardiovascular events, Cardiovascular outcomes, Clinic sites, Collaborative research group, Comparison groups, Composite outcome, Confidence interval, Control group, Coronary heart disease, Coronary revascularisation, Cumulative incidence, Daily intake, Dietary, Dietary approaches, Dietary salt reduction, Dietary sodium, Dietary sodium intake, Dietary sodium reduction, Direct association, Direct relation, Essential hypertension, Excretion, Final data, Final questionnaire, Food labels, Full intention, Further adjustment, Hazard ratio, High blood pressure, High sodium intake, Higher response, Hypertension, Hypertension incidence, Hypertension prevention, Intake, Intervention group, Intervention groups, Logistic regression, Long term, Long term effects, Lower blood pressure, Mass index, Medical records, Myocardial infarction, National health, National heart, Nonpharmacologic interventions, Nutrition examination survey, Observation data, Observational studies, Odds ratio, Online, Overweight adults, Participant, Primary outcome, Public health, Randomised, Randomised trials, Relative risk, Research group, Risk reduction, Sodium, Sodium excretion, Sodium intake, Sodium intervention, Sodium intervention control, Sodium intervention group, Sodium products, Sodium reduction, Sodium reduction intervention, Sodium reduction interventions, Stroke alderman, Study outcomes, Tohp, Total mortality, Urinary sodium excretion, Usual care, Ventricular hypertrophy, Weekly group counselling sessions, Weight loss, Weight loss intervention, Year study.
Abstract
Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II. Design Long term follow-up assessed 10-15 years after the original trial. Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34). Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.
Url:
DOI: 10.1136/bmj.39147.604896.55
Links to Exploration step
ISTEX:27EC21D42FB0516C31681F676005026DC0E781D3Le document en format XML
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Cook</name><affiliation><mods:affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: ncook@rics.bwh.harvard.edu</mods:affiliation></affiliation></author><author><name sortKey="Cutler, Jeffrey A" sort="Cutler, Jeffrey A" uniqKey="Cutler J" first="Jeffrey A" last="Cutler">Jeffrey A. Cutler</name><affiliation><mods:affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</mods:affiliation></affiliation></author><author><name sortKey="Obarzanek, Eva" sort="Obarzanek, Eva" uniqKey="Obarzanek E" first="Eva" last="Obarzanek">Eva Obarzanek</name><affiliation><mods:affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</mods:affiliation></affiliation></author><author><name sortKey="Buring, Julie E" sort="Buring, Julie E" uniqKey="Buring J" first="Julie E" last="Buring">Julie E. Buring</name><affiliation><mods:affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</mods:affiliation></affiliation></author><author><name sortKey="Rexrode, Kathryn M" sort="Rexrode, Kathryn M" uniqKey="Rexrode K" first="Kathryn M" last="Rexrode">Kathryn M. Rexrode</name><affiliation><mods:affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</mods:affiliation></affiliation></author><author><name sortKey="Kumanyika, Shiriki K" sort="Kumanyika, Shiriki K" uniqKey="Kumanyika S" first="Shiriki K" last="Kumanyika">Shiriki K. Kumanyika</name><affiliation><mods:affiliation>University of Pennsylvania School of Medicine, Philadelphia, PA</mods:affiliation></affiliation></author><author><name sortKey="Appel, Lawrence J" sort="Appel, Lawrence J" uniqKey="Appel L" first="Lawrence J" last="Appel">Lawrence J. Appel</name><affiliation><mods:affiliation>Johns Hopkins University, Baltimore, MD</mods:affiliation></affiliation></author><author><name sortKey="Whelton, Paul K" sort="Whelton, Paul K" uniqKey="Whelton P" first="Paul K" last="Whelton">Paul K. Whelton</name><affiliation><mods:affiliation>Loyola University Health System, Maywood, IL</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2007-04-28">2007-04-28</date><biblScope unit="volume">334</biblScope><biblScope unit="issue">7599</biblScope><biblScope unit="page" from="885">885</biblScope></imprint><idno type="ISSN">0959-8138</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Additional adjustment</term><term>Antihypertensive medication</term><term>Arch intern</term><term>Baseline</term><term>Baseline characteristics</term><term>Baseline sodium excretion</term><term>Baseline weight</term><term>Blood institute</term><term>Blood pressure</term><term>Blood pressure levels</term><term>Cardiovascular</term><term>Cardiovascular cause</term><term>Cardiovascular disease</term><term>Cardiovascular event</term><term>Cardiovascular events</term><term>Cardiovascular outcomes</term><term>Clinic sites</term><term>Collaborative research group</term><term>Comparison groups</term><term>Composite outcome</term><term>Confidence interval</term><term>Control group</term><term>Coronary heart disease</term><term>Coronary revascularisation</term><term>Cumulative incidence</term><term>Daily intake</term><term>Dietary</term><term>Dietary approaches</term><term>Dietary salt reduction</term><term>Dietary sodium</term><term>Dietary sodium intake</term><term>Dietary sodium reduction</term><term>Direct association</term><term>Direct relation</term><term>Essential hypertension</term><term>Excretion</term><term>Final data</term><term>Final questionnaire</term><term>Food labels</term><term>Full intention</term><term>Further adjustment</term><term>Hazard ratio</term><term>High blood pressure</term><term>High sodium intake</term><term>Higher response</term><term>Hypertension</term><term>Hypertension incidence</term><term>Hypertension prevention</term><term>Intake</term><term>Intervention group</term><term>Intervention groups</term><term>Logistic regression</term><term>Long term</term><term>Long term effects</term><term>Lower blood pressure</term><term>Mass index</term><term>Medical records</term><term>Myocardial infarction</term><term>National health</term><term>National heart</term><term>Nonpharmacologic interventions</term><term>Nutrition examination survey</term><term>Observation data</term><term>Observational studies</term><term>Odds ratio</term><term>Online</term><term>Overweight adults</term><term>Participant</term><term>Primary outcome</term><term>Public health</term><term>Randomised</term><term>Randomised trials</term><term>Relative risk</term><term>Research group</term><term>Risk reduction</term><term>Sodium</term><term>Sodium excretion</term><term>Sodium intake</term><term>Sodium intervention</term><term>Sodium intervention control</term><term>Sodium intervention group</term><term>Sodium products</term><term>Sodium reduction</term><term>Sodium reduction intervention</term><term>Sodium reduction interventions</term><term>Stroke alderman</term><term>Study outcomes</term><term>Tohp</term><term>Total mortality</term><term>Urinary sodium excretion</term><term>Usual care</term><term>Ventricular hypertrophy</term><term>Weekly group counselling sessions</term><term>Weight loss</term><term>Weight loss intervention</term><term>Year study</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II. Design Long term follow-up assessed 10-15 years after the original trial. Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34). Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>tohp</json:string><json:string>hypertension</json:string><json:string>blood pressure</json:string><json:string>sodium reduction</json:string><json:string>cardiovascular disease</json:string><json:string>cardiovascular</json:string><json:string>randomised</json:string><json:string>hypertension prevention</json:string><json:string>sodium intake</json:string><json:string>sodium excretion</json:string><json:string>sodium reduction intervention</json:string><json:string>weight loss</json:string><json:string>dietary sodium intake</json:string><json:string>excretion</json:string><json:string>baseline</json:string><json:string>online</json:string><json:string>sodium intervention</json:string><json:string>total mortality</json:string><json:string>usual 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Obarzanek</name><affiliations><json:string>National Heart, Lung, and Blood Institute, Bethesda, MD</json:string></affiliations></json:item><json:item><name>Julie E Buring</name><affiliations><json:string>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</json:string></affiliations></json:item><json:item><name>Kathryn M Rexrode</name><affiliations><json:string>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</json:string></affiliations></json:item><json:item><name>Shiriki K Kumanyika</name><affiliations><json:string>University of Pennsylvania School of Medicine, Philadelphia, PA</json:string></affiliations></json:item><json:item><name>Lawrence J Appel</name><affiliations><json:string>Johns Hopkins University, Baltimore, MD</json:string></affiliations></json:item><json:item><name>Paul K Whelton</name><affiliations><json:string>Loyola University Health System, Maywood, IL</json:string></affiliations></json:item></author><articleId><json:string>coon425397</json:string></articleId><arkIstex>ark:/67375/NVC-WV6V7CLV-4</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II. Design Long term follow-up assessed 10-15 years after the original trial. Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34). 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effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">British Medical Journal Publishing Group</publisher><availability><licence><p>© BMJ Publishing Group Ltd 2007</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</p></availability><date>2007-04-20</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">Nancy R</forename><surname>Cook</surname></persName><email>ncook@rics.bwh.harvard.edu</email><note type="biography">associate professor</note><affiliation>associate professor</affiliation><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Jeffrey A</forename><surname>Cutler</surname></persName><note type="biography">former senior scientific adviser</note><affiliation>former senior scientific adviser</affiliation><affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Eva</forename><surname>Obarzanek</surname></persName><note type="biography">research nutritionist</note><affiliation>research nutritionist</affiliation><affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Julie E</forename><surname>Buring</surname></persName><note type="biography">professor</note><affiliation>professor</affiliation><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Kathryn M</forename><surname>Rexrode</surname></persName><note type="biography">assistant professor of medicine</note><affiliation>assistant professor of medicine</affiliation><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Shiriki K</forename><surname>Kumanyika</surname></persName><note type="biography">professor of epidemiology</note><affiliation>professor of epidemiology</affiliation><affiliation>University of Pennsylvania School of Medicine, Philadelphia, PA</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Lawrence J</forename><surname>Appel</surname></persName><note type="biography">professor of medicine</note><affiliation>professor of medicine</affiliation><affiliation>Johns Hopkins University, Baltimore, MD</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Paul K</forename><surname>Whelton</surname></persName><note type="biography">president and chief executive officer</note><affiliation>president and chief executive officer</affiliation><affiliation>Loyola University Health System, Maywood, IL</affiliation></author><idno type="istex">27EC21D42FB0516C31681F676005026DC0E781D3</idno><idno type="ark">ark:/67375/NVC-WV6V7CLV-4</idno><idno type="DOI">10.1136/bmj.39147.604896.55</idno><idno type="href">bmj-334-885.pdf</idno><idno type="article-id">coon425397</idno><idno type="PMID">17449506</idno><idno type="local">bmj;334/7599/885</idno></analytic><monogr><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="pISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><idno type="publisher-id">bmj</idno><idno type="PublisherID-hwp">bmj</idno><idno type="PublisherID-nlm-ta">BMJ</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2007-04-28"></date><biblScope unit="volume">334</biblScope><biblScope unit="issue">7599</biblScope><biblScope unit="page" from="885">885</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2007-04-20</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II. Design Long term follow-up assessed 10-15 years after the original trial. Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34). Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Clinical trials (epidemiology)</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Epidemiologic studies</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Drugs: cardiovascular system</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Stroke</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Hypertension</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Diet</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Ischaemic heart disease</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2007-04-20">Created</change><change when="2007-04-28">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-WV6V7CLV-4/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">coon425397</article-id><article-id pub-id-type="doi">10.1136/bmj.39147.604896.55</article-id><article-id pub-id-type="other">bmj;334/7599/885</article-id><article-id pub-id-type="other">bmj;bmj.39147.604896.55</article-id><article-id pub-id-type="pmid">17449506</article-id><article-id pub-id-type="other">885</article-id><article-id pub-id-type="other">bmj.39147.604896.55</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Clinical trials (epidemiology)</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Epidemiologic studies</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Drugs: cardiovascular system</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Stroke</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Hypertension</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Diet</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Ischaemic heart disease</subject></subj-group></article-categories><title-group><article-title>Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" xlink:type="simple"><name name-style="western"><surname>Cook</surname><given-names>Nancy R</given-names></name><role>associate professor</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Cutler</surname><given-names>Jeffrey A</given-names></name><role>former senior scientific adviser</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Obarzanek</surname><given-names>Eva</given-names></name><role>research nutritionist</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Buring</surname><given-names>Julie E</given-names></name><role>professor</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Rexrode</surname><given-names>Kathryn M</given-names></name><role>assistant professor of medicine</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kumanyika</surname><given-names>Shiriki K</given-names></name><role>professor of epidemiology</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Appel</surname><given-names>Lawrence J</given-names></name><role>professor of medicine</role><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Whelton</surname><given-names>Paul K</given-names></name><role>president and chief executive officer</role><xref ref-type="aff" rid="aff5">5</xref></contrib><aff id="aff1"><label>1</label>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</aff><aff id="aff2"><label>2</label>National Heart, Lung, and Blood Institute, Bethesda, MD</aff><aff id="aff3"><label>3</label>University of Pennsylvania School of Medicine, Philadelphia, PA</aff><aff id="aff4"><label>4</label>Johns Hopkins University, Baltimore, MD</aff><aff id="aff5"><label>5</label>Loyola University Health System, Maywood, IL</aff></contrib-group><author-notes><corresp>Correspondence to: N Cook <email xlink:type="simple">ncook@rics.bwh.harvard.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>28</day><month>4</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>20</day><month>4</month><year>2007</year></pub-date><volume>334</volume><volume-id pub-id-type="other">334</volume-id><volume-id pub-id-type="other">334</volume-id><issue>7599</issue><issue-id pub-id-type="other">bmj;334/7599</issue-id><issue-id pub-id-type="other">7599</issue-id><issue-id pub-id-type="other">334/7599</issue-id><fpage>885</fpage><history><date date-type="accepted"><day>7</day><month>February</month><year>2007</year></date></history><permissions><copyright-statement>© BMJ Publishing Group Ltd 2007</copyright-statement><copyright-year>2007</copyright-year><copyright-holder>BMJ Publishing Group Ltd</copyright-holder></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-334-885.pdf"></self-uri><abstract><p><bold>Objective</bold> To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II.</p><p><bold>Design </bold>Long term follow-up assessed 10-15 years after the original trial.</p><p><bold>Setting </bold>10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone.</p><p><bold>Participants</bold> Adults aged 30-54 years with prehypertension.</p><p><bold>Intervention</bold> Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II).</p><p><bold>Main outcome measure</bold> Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death).</p><p><bold>Results</bold> 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34).</p><p><bold>Conclusion</bold> Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Nancy R</namePart><namePart type="family">Cook</namePart><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation><affiliation>E-mail: ncook@rics.bwh.harvard.edu</affiliation><description>associate professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jeffrey A</namePart><namePart type="family">Cutler</namePart><affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</affiliation><description>former senior scientific adviser</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eva</namePart><namePart type="family">Obarzanek</namePart><affiliation>National Heart, Lung, and Blood Institute, Bethesda, MD</affiliation><description>research nutritionist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Julie E</namePart><namePart type="family">Buring</namePart><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation><description>professor</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kathryn M</namePart><namePart type="family">Rexrode</namePart><affiliation>Brigham and Women's Hospital, Harvard Medical School, Boston, MA</affiliation><description>assistant professor of medicine</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Shiriki K</namePart><namePart type="family">Kumanyika</namePart><affiliation>University of Pennsylvania School of Medicine, Philadelphia, PA</affiliation><description>professor of epidemiology</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lawrence J</namePart><namePart type="family">Appel</namePart><affiliation>Johns Hopkins University, Baltimore, MD</affiliation><description>professor of medicine</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paul K</namePart><namePart type="family">Whelton</namePart><affiliation>Loyola University Health System, Maywood, IL</affiliation><description>president and chief executive officer</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2007-04-28</dateIssued><dateCreated encoding="w3cdtf">2007-04-20</dateCreated><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II. Design Long term follow-up assessed 10-15 years after the original trial. Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34). 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