Ruzicka Marcel, Hiremath Swapnil, Steiner Sabine, Helis Eftyhia, Szczotka Agnieszka, Baker Penelope, Fodor George
aDivision of Nephrology, The Ottawa Hospital bDivision of Cardiology, University of Ottawa Heart Institute cDivision of Angiology/Vascular Medicine, Department of Internal Medicine II, Medical University Vienna dDivision of Prevention and Rehabilitation eBerkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
J Hypertens. 2014 Jul;32(7):1388-94; discussion 1394. doi: 10.1097/HJH.0000000000000182.
To evaluate whether efficacious counseling methods on sodium restriction can be successfully incorporated into primary care models for the management of hypertension.
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment to identify randomized controlled trials of dietary counseling for salt intake reduction that reported significant reduction in 24-h urinary sodium and blood pressure levels among adults with untreated hypertension. Data extraction and assessment of reproducibility and feasibility were done in duplicate and any disagreements were resolved by consensus.
Six trials were included for assessment of methods as they were efficacious in reducing sodium intake (24-h urinary sodium excretion) by 73 to 93 mmol/day (intervention) vs. 3.2 to 12.5 mmol/day (control). This was paralleled with a reduction in blood pressure (-4 to -27 mmHg) between groups. In four of the six trials, the methods were described in sufficient detail to be reproducible, but in none of these trials were the 'counseling methods' feasible for application in primary care settings. Apart from multiple sessions of counseling, the reported interventions were supplemented with provision of prepared food, community cooking classes, and intensive inpatient training sessions.
Despite the availability of efficacious counseling methods for the reduction of sodium intake among newly diagnosed hypertensive patients (feasible within a clinical trial setting), none of these methods, in their present form, are suitable for incorporation into existing primary care settings in countries such as Canada, United States, and UK.
评估有效的限钠咨询方法能否成功纳入原发性高血压管理的初级保健模式。
我们检索了MEDLINE、Embase、Cochrane对照试验中央注册库、效果摘要数据库和卫生技术评估数据库，以确定关于减少盐摄入量的饮食咨询的随机对照试验，这些试验报告了未治疗的高血压成人24小时尿钠和血压水平显著降低。数据提取以及对可重复性和可行性的评估由两人独立进行，任何分歧通过协商解决。
六项试验被纳入方法评估，因为它们能有效降低钠摄入量（24小时尿钠排泄量），干预组为每天73至93毫摩尔，对照组为每天3.2至12.5毫摩尔。两组间血压也相应降低（-4至-27毫米汞柱）。在六项试验中的四项中，对方法的描述足够详细以便重复，但在这些试验中没有一项的“咨询方法”适用于初级保健环境。除了多次咨询外，报告的干预措施还包括提供预制食品、社区烹饪课程和强化住院培训课程。
尽管有有效的咨询方法可降低新诊断高血压患者的钠摄入量（在临床试验环境中可行），但目前这些方法均不适用于纳入加拿大、美国和英国等国家现有的初级保健环境。
