Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)

doi:10.1136/bmj.39147.604896.55

BMJ 2007;334:885 (28 April), doi:10.1136/bmj.39147.604896.55 (published 20 April 2007)

Research

Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)

Nancy R Cook, associate professor¹, Jeffrey A Cutler, former senior scientific adviser², Eva Obarzanek, research nutritionist², Julie E Buring, professor¹, Kathryn M Rexrode, assistant professor of medicine¹, Shiriki K Kumanyika, professor of epidemiology³, Lawrence J Appel, professor of medicine⁴, Paul K Whelton, president and chief executive officer⁵

¹ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, ² National Heart, Lung, and Blood Institute, Bethesda, MD, ³ University of Pennsylvania School of Medicine, Philadelphia, PA, ⁴ Johns Hopkins University, Baltimore, MD, ⁵ Loyola University Health System, Maywood, IL

Correspondence to: N Cook ncook{at}rics.bwh.harvard.edu

Objective To examine the effects of reduction in dietary sodiumintake on cardiovascular events using data from two completedrandomised trials, TOHP I and TOHP II.

Design Long term follow-up assessed 10-15 years after the originaltrial.

Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in1990-5 (TOHP II). Central follow-up conducted by post and phone.

Participants Adults aged 30-54 years with prehypertension.

Intervention Dietary sodium reduction, including comprehensiveeducation 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 wererandomised to a sodium reduction intervention or control. Netsodium reductions in the intervention groups were 44 mmol/24h and 33 mmol/24 h, respectively. Vital status was obtainedfor all participants and follow-up information on morbiditywas obtained from 2415 (77%), with 200 reporting a cardiovascularevent. Risk of a cardiovascular event was 25% lower among thosein the intervention group (relative risk 0.75, 95% confidenceinterval 0.57 to 0.99, P=0.04), adjusted for trial, clinic,age, race, and sex, and 30% lower after further adjustment forbaseline sodium excretion and weight (0.70, 0.53 to 0.94), withsimilar results in each trial. In secondary analyses, 67 participantsdied (0.80, 0.51 to 1.26, P=0.34).

Conclusion Sodium reduction, previously shown to lower bloodpressure, may also reduce long term risk of cardiovascular events.

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