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WASHINGTON, March 12, Mar 12, 2001 (United Press International via COMTEX) -- Many elderly patients could be weaned off blood pressure medications if they reduced their salt intake through dietary counseling, say researchers at Johns Hopkins School of Medicine.
"While sodium reduction is widely advocated as a means to reduce BP and control hypertension in older persons, empiric evidence is sparse," Dr. Lawrence Appel told United Press International. "We have found that many patients taking various hypertension medications can control their blood pressure without drugs if they undergo counseling to reduce sodium in their diet and adhere to the restrictions."
Appel and his associates conducted the study in 681 patients, all of whom had their blood pressure controlled with drugs at the study's outset. These included beta and calcium channel blockers, diuretics and other medications. After three months, participants were gradually taken off their medication and, after two years, about one in three patients were able to control their blood pressure without medication, some at levels below those achieved when they took drugs.
"What was even more amazing is that this effect was consistent among patients of different races and different sexes -- across the board. That hasn't been shown before," Appel said.
Sodium reduction can be particularly effective in older persons, he noted. Because arterial compliance decreases with age, any change in blood volume related to sodium intake should result in a greater BP change in older persons. Declining kidney function could cause older individuals to retain more sodium than younger persons. Older persons also may be more willing and able to reduce their sodium intake than younger individuals, who have yet to experience the adverse health consequences of elevated blood pressure, the researchers said.
"There has been a misperception that older patients can't make lifestyle changes that will reduce their blood pressure. We found this isn't so," Appel told UPI. "Instead, when it comes to reducing blood pressure through sodium restriction, the more the better, especially in African-Americans."
Few studies have been done on salt restrictions in elderly hypertensives, and none of those have included African-Americans, Appel said. In this study, 23 percent were African-Americans and 47 percent were women. On average, participants had hypertension for 13 years and had been taking antihypertensive medication for 12 years.
The reduced-sodium group was able to maintain a substantial reduction in sodium levels. At the 9-, 18-, and 30-month follow-up visits, more than 40 percent of reduced-sodium participants had acceptable urinary sodium levels, compared with less than 15 percent of other participants.
"The effects were consistent in subgroups defined by sex, ethnicity, and weight status and, in aggregate, the data indicate that a modest reduction in sodium intake is a feasible and broadly effective nonpharmacologic therapy" in older persons with high blood pressure, Appel said.
"This is another solid study that shows the safety, efficacy and benefits of salt restriction in controlling high blood pressure, especially older patients," said Ed Roccella, coordinator of the national high blood pressure education program at the National Institutes of Health. "The more the better -- the more they lowered sodium, the lower their end-points and the better their blood pressure. It's no mystery."
Roccella said reducing salt can be difficult, however, without proper counseling. "This isn't about the salt shaker," he told UPI. "As much as 80 percent of sodium is in the manufacturing process and much of it is unnecessary. The problem is knowing how to identify and avoid this hidden salt, and that usually takes some type of education and counseling."
(Reported by UPI Medical Writer Kurt Samson in Washington)
Copyright 2001 by United Press International.
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