Sodium reduction and weight loss in the treatment of hypertension in older persons - A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE)
Sodium reduction and weight loss in the treatment of hypertension in older persons - A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE)
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DOI：
10.1001/jama.279.11.839
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发表时间：
1998-03-18
影响因子：
120.7
通讯作者：
Cutler, JA
中科院分区：
文献类型：
--
作者：
Whelton, PK;Appel, LJ;Cutler, JA
背景。-非药物干预经常被推荐用于治疗老年高血压，但缺乏随机对照试验的证据支持这种治疗。为了确定是否减肥或减少钠的摄入量是有效的治疗老年人高血压。随机对照试验。内裤。-共有875名年龄在60至80岁之间的男性和女性，收缩压低于145 mm Hg，舒张压低于85 mm Hg，同时接受单一抗高血压药物治疗。四个学术健康中心。干预。585名肥胖参与者被随机分配到减少钠摄入量、减肥、两者兼而有之或常规护理组，390名非肥胖参与者被随机分配到减少钠摄入量或常规护理组，干预3个月后尝试停用抗高血压药物。在1次或多次随访时诊断为高血压，或使用抗高血压药物治疗，或在随访期间发生心血管事件（范围，15-36个月;中位数，29个月）。联合结果测量在分配到减少钠摄入的患者中的发生率低于未分配到减少钠摄入的患者（相对风险比，0.69; 95%置信区间[CI]，0.59-0.81; P
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 persons 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, or 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