He J, Whelton P K, Appel L J, Charleston J, Klag M J
Department of Epidemiology, the Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112-2699, USA.
Hypertension. 2000 Feb;35(2):544-9. doi: 10.1161/01.hyp.35.2.544.
To examine the long-term effects of weight loss and dietary sodium reduction on the incidence of hypertension, we studied 181 men and women who participated in the Trials of Hypertension Prevention, phase 1, in Baltimore, Md. At baseline (1987 to 1988), subjects were 30 to 54 years old and had a diastolic blood pressure (BP) of 80 to 89 mm Hg and systolic BP <160 mm Hg. They were randomly assigned to one of two 18-month lifestyle modification interventions aimed at either weight loss or dietary sodium reduction or to a usual care control group. At the posttrial follow-up (1994 to 1995), BP was measured by blinded observers who used a random-zero sphygmomanometer. Incident hypertension was defined as systolic BP > or =160 mm Hg and/or diastolic BP > or =90 mm Hg and/or treatment with antihypertensive medication during follow-up. Body weight and urinary sodium were not significantly different among the groups at the posttrial follow-up. After 7 years of follow-up, the incidence of hypertension was 18.9% in the weight loss group and 40.5% in its control group and 22.4% in the sodium reduction group and 32.9% in its control group. In logistic regression analysis adjusted for baseline age, gender, race, physical activity, alcohol consumption, education, body weight, systolic BP, and urinary sodium excretion, the odds of hypertension was reduced by 77% (odds ratio 0.23; 95% confidence interval 0.07 to 0.76; P=0.02) in the weight loss group and by 35% (odds ratio 0.65; 95% confidence interval 0.25 to 1.69; P=0.37) in the sodium reduction group compared with their control groups. These results indicate that lifestyle modification such as weight loss may be effective in long-term primary prevention of hypertension.
为研究体重减轻和饮食中钠摄入量减少对高血压发病率的长期影响，我们对参与马里兰州巴尔的摩市高血压预防试验第一阶段的181名男性和女性进行了研究。在基线期（1987年至1988年），受试者年龄在30至54岁之间，舒张压（BP）为80至89毫米汞柱，收缩压<160毫米汞柱。他们被随机分配到两种为期18个月的生活方式改变干预措施之一，一种旨在减轻体重，另一种旨在减少饮食中的钠摄入量，或者被分配到常规护理对照组。在试验后随访期（1994年至1995年），由使用随机零点血压计的盲法观察者测量血压。随访期间，将收缩压≥160毫米汞柱和/或舒张压≥90毫米汞柱和/或接受抗高血压药物治疗定义为发生高血压。试验后随访时，各组之间的体重和尿钠水平无显著差异。经过7年的随访，体重减轻组的高血压发病率为18.9%，其对照组为40.5%；钠摄入量减少组为22.4%，其对照组为32.9%。在对基线年龄、性别、种族、身体活动、饮酒量、教育程度、体重、收缩压和尿钠排泄进行校正的逻辑回归分析中，与对照组相比，体重减轻组发生高血压的几率降低了77%（比值比0.23；95%置信区间0.07至0.76；P=0.02），钠摄入量减少组降低了35%（比值比0.65；95%置信区间0.25至1.69；P=0.37）。这些结果表明，诸如体重减轻等生活方式改变可能对高血压的长期一级预防有效。
