Juraschek Stephen P, Woodward Mark, Sacks Frank M, Carey Vincent J, Miller Edgar R, Appel Lawrence J
From the Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.P.J., M.W., E.R.M., L.J.A.); Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD (S.P.J., M.W., E.R.M., L.J.A.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.P.J.); the George Institute for Global Health, University of Oxford, United Kingdom (M.W.); the George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W.); and Harvard T.H. Chan School of Public Health, Harvard Medical School, Brigham & Women's Hospital, Boston, MA (F.M.S., V.J.C.).
Hypertension. 2017 Nov;70(5):923-929. doi: 10.1161/HYPERTENSIONAHA.117.10017.
Both sodium reduction and the Dietary Approaches to Stop Hypertension (DASH) diet lower blood pressure (BP); however, the patterns of their effects on BP over time are unknown. In the DASH-Sodium trial, adults with pre-/stage 1 hypertension, not using antihypertensive medications, were randomly assigned to either a typical American diet (control) or DASH. Within their assigned diet, participants randomly ate each of 3 sodium levels (50, 100, and 150 mmol/d, at 2100 kcal) over 4-week periods. BP was measured weekly for 12 weeks; 412 participants enrolled (57% women; 57% black; mean age, 48 years; mean systolic BP [SBP]/diastolic BP [DBP], 135/86 mm Hg). For those assigned control, there was no change in SBP/DBP between weeks 1 and 4 on the high-sodium diet (weekly change, -0.04/0.06 mm Hg/week) versus a progressive decline in BP on the low-sodium diet (-0.94/-0.70 mm Hg/week; interactions between time and sodium <0.001 for SBP and DBP). For those assigned DASH, SBP/DBP changed -0.60/-0.16 mm Hg/week on the high- versus -0.42/-0.54 mm Hg/week on the low-sodium diet ( interactions between time and sodium=0.56 for SBP and 0.10 for DBP). When comparing DASH to control, DASH changed SBP/DBP by -4.36/-1.07 mm Hg after 1 week, which accounted for most of the effect observed, with no significant difference in weekly rates of change for either SBP ( interaction=0.97) or DBP ( interaction=0.70). In the context of a typical American diet, a low-sodium diet reduced BP without plateau, suggesting that the full effects of sodium reduction are not completely achieved by 4 weeks. In contrast, compared with control, DASH lowers BP within a week without further effect thereafter.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000608.
减少钠摄入和采用终止高血压饮食疗法（DASH饮食）均能降低血压（BP）；然而，随着时间推移它们对血压的影响模式尚不清楚。在DASH-钠试验中，未使用抗高血压药物的高血压前期/1期成年人被随机分配到典型美国饮食组（对照组）或DASH饮食组。在各自分配的饮食组中，参与者在4周期间随机食用三种钠水平（50、100和150 mmol/d，热量为2100千卡）中的每一种。每周测量血压，持续12周；412名参与者入组（57%为女性；57%为黑人；平均年龄48岁；平均收缩压[SBP]/舒张压[DBP]为135/86 mmHg）。对于分配到对照组的人，高钠饮食第1周和第4周之间SBP/DBP无变化（每周变化-0.04/0.06 mmHg/周），而低钠饮食时血压呈逐渐下降趋势（-0.94/-0.70 mmHg/周；时间和钠之间的交互作用，SBP和DBP均<0.001）。对于分配到DASH饮食组的人，高钠饮食时SBP/DBP每周变化-0.60/-0.16 mmHg，低钠饮食时为-0.42/-0.54 mmHg（时间和钠之间的交互作用，SBP为0.56，DBP为0.10）。将DASH饮食组与对照组比较时，1周后DASH饮食组SBP/DBP变化-4.36/-1.07 mmHg，这占观察到的大部分效应，SBP（交互作用=0.97）或DBP（交互作用=0.70）的每周变化率无显著差异。在典型美国饮食背景下，低钠饮食可降低血压且无平台期，表明4周时未完全实现减少钠摄入的全部效果。相比之下，与对照组相比，DASH饮食在1周内降低血压，此后无进一步效果。
