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Effects of Diet and Sodium Intake on Blood Pressure: Subgroup Analysis of the DASH-Sodium Trial

William M. Vollmer, PhD; Frank M. Sacks, MD; Jamy Ard, MD; Lawrence J. Appel, MD; George A. Bray, MD; Denise G. Simons-Morton, MD, PhD; Paul R. Conlin, MD; Laura P. Svetkey, MD; Thomas P. Erlinger, MD; Thomas J. Moore, MD; Njeri Karanja, PhD, DASH-Sodium Trial Collaborative Research Group
[+] Article and Author Information

From the Center for Health Research, Portland, Oregon; Brigham and Women's Hospital and Boston University Medical Center, Boston, Massachusetts; Duke University Medical Center, Durham, North Carolina; Johns Hopkins University, Baltimore, and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and Pennington Biomedical Research Center, Baton Rouge, Louisiana.


* For participants in the DASH-Sodium Trial Collaborative Research Group, see the Appendix.

Acknowledgments: The authors thank the trial participants for their sustained commitment to the DASH-Sodium Trial; the external Protocol Review Committee (Jeremiah Stamler, MD [Chair], Jackson T. Wright, MD, PhD, Lemuel A. Moye, MD, PhD, Janice A. Derr, PhD, and Richard D. Mattes, PhD); and the Data and Safety Monitoring Board (Richard Grimm, MD [Chair], Jeremiah Stamler, MD, Jackson T. Wright, MD, PhD, Avital Cnaan, PhD, Janice A. Derr, PhD, and Richard D. Mattes, PhD). They also thank the companies that donated food: Almond Board of California, Beatrice Foods, Best Foods, Cabot Creamery, Curtis Burns Foods, Dannon Company, Diamond Crystal Specialty Foods, Elwood International, Hershey Foods Corp., Hormel Foods, Kellogg Company, Lipton Co., McCormick Spice Co., Nabisco Foods, Proctor & Gamble Co., Quaker Oats Co., and Sunmaid Growers, and Frost Cold Storage for food storage.

Grant Support: By a cooperative agreement and other awards from the National Heart, Lung, and Blood Institute, National Institutes of Health, to Brigham and Women's Hospital (U01-HL 57173), Duke University (U01-HL57114), Pennington Biomedical Research Institute (U01-HL57190), Johns Hopkins University (U01-HL57139 and K08 HL03857-01), and Kaiser Permanente Center for Health Research (U01-HL57156), and from the General Clinical Research Center Program of the National Center for Research Resources, National Institutes of Health, to Brigham and Women's Hospital (M01-RR02635) and Johns Hopkins University (M01-RR00722).

Requests for Single Reprints: William M. Vollmer, PhD, Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227-1110; e-mail, william.vollmer@kpchr.org.

Current Author Addresses: Drs. Vollmer and Karanja: Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

Drs. Sacks and Conlin: Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115.

Drs. Ard and Svetkey: Duke University Medical Center, 3020 Pickett Road, Durham. NC 27705.

Drs. Appel and Erlinger: Johns Hopkins University, 2024 East Monument Street, Suite 2-602, Baltimore, MD 21205.

Dr. Bray: Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808.

Dr. Simons-Morton: National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892.

Dr. Moore: Boston University School of Medicine, 715 Albany Street, Boston, MA 02118.

Author Contributions: Conception and design: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

Analysis and interpretation of the data: W.M. Vollmer, J. Ard, L.J. Appel, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

Drafting of the article: W.M. Vollmer, F.M. Sacks, J. Ard, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.

Critical revision of the article for important intellectual content: W.M. Vollmer, F.M. Sacks, J. Ard, L.J. Appel, G.A. Bray, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.P. Erlinger, T.J. Moore.

Final approval of the article: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.P. Erlinger, T.J. Moore.

Provision of study materials or patients: F.M. Sacks, L.J. Appel, P.R. Conlin, L.P. Svetkey.

Statistical expertise: W.M. Vollmer.

Obtaining of funding: W.M. Vollmer, F.M. Sacks, L.J. Appel, G.A. Bray, L.P. Svetkey, T.J. Moore, N. Karanja.

Administrative, technical, or logistic support: W.M. Vollmer, D.G. Simons-Morton, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja

Collection and assembly of data: W.M. Vollmer, L.J. Appel, G.A. Bray, P.R. Conlin, L.P. Svetkey, T.J. Moore, N. Karanja.


Ann Intern Med. 2001;135(12):1019-1028. doi:10.7326/0003-4819-135-12-200112180-00005
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Although epidemiologic data show a direct relation between dietary sodium intake and blood pressure at the population level (12), some experts question the universality of the findings and oppose public health recommendations to decrease sodium intake in the general population (3). Certainly, results from reports on the relationship between sodium and blood pressure among major subgroups vary considerably. Several studies suggest that African Americans and older adults have heightened salt sensitivity (greater blood pressure response to sodium intake) (46). Some evidence also indicates increased salt sensitivity in women (7), although other studies do not support this claim (45). The association of sodium intake with cardiovascular morbidity and mortality varies by overweight status (8), perhaps reflecting a differential effect of sodium on blood pressure in overweight persons. Finally, higher dietary intakes of potassium and calcium have been shown to blunt the pressor effects of dietary sodium (910).

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Figure.
Design of the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial.

During the run-in phase, the higher sodium level was used. During the intervention period, the three 30-day segments were offered in random order.

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Summary for Patients

Special Diets Decrease Blood Pressure

The summary below is from the full report titled “Effects of Diet and Sodium Intake on Blood Pressure: Subgroup Analysis of the DASH-Sodium Trial.” It is in the 18 December 2001 issue of Annals of Internal Medicine (volume 135; pages 1019-1028). The authors are WM Vollmer, FM Sacks, J Ard, LJ Appel, GA Bray, DG Simons-Morton, PR Conlin, LP Svetkey, TP Erlinger, TJ Moore, and N Karanja, for the DASH- Sodium Trial Collaborative Research Group.

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