This proposal is designed to test the hypothesis that an increased intake of potassium coupled with a reduction in sodium intake, and/or calcium supplementation will prevent the expected age related increase in blood pressure and thereby forestall the development of hypertension. Of the many non-pharmacological interventions that have been proposed as strategies for hypertension prevention the majority of existing evidence favors our nutritional approach as the one most likely to yield significant results. As part of a collaborative approach to the study of non-pharmacologic interventions, we propose to enroll approximately 200 subjects, aged 25-49 in a randomized parallel trial which will test the previously stated hypothesis. The study will have a factorial design that results in the four groups assigned to the following treatment regimens: (1) Low sodium (less than 70 mEQ/day), high potassium (greater than 100 mEq/day) intake (2) Calcium supplementation with 1500 mg elemental calcium/day (3) Combination of the approaches in (1) and (2) (4) Placebo supplementation but no dietary modification The strategy to be used for dietary modification will be based, primarily, upon withdrawal of bread and cereals with isocaloric substitution of potatoes, rice and/or other vegetable sources of complex carbohydrates. Preliminary studies show that this will readily achieve our goal sodium (less than 70 mEQ/day) and potassium (greater than 100 mEq/day) intake levels with a molar sodium/potassium ration less than 1. A positive result that interrupts the expected increase in age related blood pressure would provide the basis for a most important hypertension prevention mass treatment strategy.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01HL037924-07
Application #
3552895
Study Section
Special Emphasis Panel (SRC (ZZ))
Project Start
1986-09-30
Project End
1995-06-30
Budget Start
1992-07-01
Budget End
1993-06-30
Support Year
7
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Type
Schools of Public Health
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Cook, Nancy R; Appel, Lawrence J; Whelton, Paul K (2014) Lower levels of sodium intake and reduced cardiovascular risk. Circulation 129:981-9
Cook, Nancy R; Obarzanek, Eva; Cutler, Jeffrey A et al. (2009) Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med 169:32-40
Cook, Nancy R; Cutler, Jeffrey A; Obarzanek, Eva et al. (2007) Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 334:885-8
Kumanyika, S K; Cook, N R; Cutler, J A et al. (2005) Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II. J Hum Hypertens 19:33-45
Cook, N R; Kumanyika, S K; Cutler, J A et al. (2005) Dose-response of sodium excretion and blood pressure change among overweight, nonhypertensive adults in a 3-year dietary intervention study. J Hum Hypertens 19:47-54
Stevens, V J; Obarzanek, E; Cook, N R et al. (2001) Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 134:1-11
He, J; Whelton, P K; Appel, L J et al. (2000) Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 35:544-9
Hunt, S C; Cook, N R; Oberman, A et al. (1998) Angiotensinogen genotype, sodium reduction, weight loss, and prevention of hypertension: trials of hypertension prevention, phase II. Hypertension 32:393-401
(1997) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborativ Arch Intern Med 157:657-67
Yamamoto, M E; Applegate, W B; Klag, M J et al. (1995) Lack of blood pressure effect with calcium and magnesium supplementation in adults with high-normal blood pressure. Results from Phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOHP) Collaborative Research Group Ann Epidemiol 5:96-107

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