Sodium reduction and weight loss in the treatment of hypertension in older persons

A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE)

Paul K. Whelton, Lawrence J. Appel, Mark A. Espeland, William B. Applegate, Walter H. Ettinger, John B. Kostis, Shiriki Kumanyika, Clifton R. Lacy, Karen Johnson, Steven Folmar, Jeffrey A. Cutler

Research output: Contribution to journalArticle

859 Citations (Scopus)

Abstract

Context. - Nonpharmacologic 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. Objective. - To determine whether weight loss or reduced sodium intake is effective in the treatment of older parsons with hypertension. Design. - Randomized controlled trial. Participants. - A total of 875 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. Setting. - Four academic health centers. Intervention. -The 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 Measure. - Diagnosis of high blood pressure at 1 or more follow- up visits, treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months). Results. - The 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 and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups. Conclusion. - Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

Original languageEnglish (US)
Pages (from-to)839-846
Number of pages8
JournalJournal of the American Medical Association
Volume279
Issue number11
DOIs
StatePublished - Mar 18 1998

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Weight Loss
Randomized Controlled Trials
Sodium
Hypertension
Confidence Intervals
Antihypertensive Agents
Blood Pressure
Therapeutics
Outcome Assessment (Health Care)
Health

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sodium reduction and weight loss in the treatment of hypertension in older persons : A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). / Whelton, Paul K.; Appel, Lawrence J.; Espeland, Mark A.; Applegate, William B.; Ettinger, Walter H.; Kostis, John B.; Kumanyika, Shiriki; Lacy, Clifton R.; Johnson, Karen; Folmar, Steven; Cutler, Jeffrey A.

In: Journal of the American Medical Association, Vol. 279, No. 11, 18.03.1998, p. 839-846.

Research output: Contribution to journalArticle

Whelton, Paul K. ; Appel, Lawrence J. ; Espeland, Mark A. ; Applegate, William B. ; Ettinger, Walter H. ; Kostis, John B. ; Kumanyika, Shiriki ; Lacy, Clifton R. ; Johnson, Karen ; Folmar, Steven ; Cutler, Jeffrey A. / Sodium reduction and weight loss in the treatment of hypertension in older persons : A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). In: Journal of the American Medical Association. 1998 ; Vol. 279, No. 11. pp. 839-846.
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abstract = "Context. - Nonpharmacologic 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. Objective. - To determine whether weight loss or reduced sodium intake is effective in the treatment of older parsons with hypertension. Design. - Randomized controlled trial. Participants. - A total of 875 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. Setting. - Four academic health centers. Intervention. -The 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 Measure. - Diagnosis of high blood pressure at 1 or more follow- up visits, treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months). Results. - The 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 and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups. Conclusion. - Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.",
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AU - Espeland, Mark A.

AU - Applegate, William B.

AU - Ettinger, Walter H.

AU - Kostis, John B.

AU - Kumanyika, Shiriki

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AU - Johnson, Karen

AU - Folmar, Steven

AU - Cutler, Jeffrey A.

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N2 - Context. - Nonpharmacologic 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. Objective. - To determine whether weight loss or reduced sodium intake is effective in the treatment of older parsons with hypertension. Design. - Randomized controlled trial. Participants. - A total of 875 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. Setting. - Four academic health centers. Intervention. -The 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 Measure. - Diagnosis of high blood pressure at 1 or more follow- up visits, treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months). Results. - The 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 and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups. Conclusion. - Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

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