The Trials of Hypertension Prevention (TOHP) - dummies

The Trials of Hypertension Prevention (TOHP)

By Sarah Samaan, Rosanne Rust, Cynthia Kleckner

A landmark series of studies known as the Trials of Hypertension Prevention (TOHP) was designed to sort out whether reducing sodium would improve blood pressure in people with pre-hypertension. The goal was set at 1,800 milligrams of sodium daily, with a separate control group that was given no restrictions at all. The participants were free to choose their own foods but received professional dietary counseling and motivation throughout.

Although not everyone was 100 percent successful with the sodium goal, at the 6-month point, on average, systolic blood pressure fell by about 3 points and diastolic by about 1.5 points compared to those who continued on with their usual diets. When the researchers looked at those who were most faithful to the program, both numbers dropped by about 5 points.

That may not sound very impressive, but if everyone followed the same simple plan, even without perfect compliance, the researchers estimated that the annual rate of heart disease could be reduced by more than 5 percent and strokes would drop by nearly 14 percent — meaningful numbers when you think about them in terms of yourself, your family, and your friends. Furthermore, rather than being miserable, participants on the low-sodium plan scored higher on tests of psychological well-being. Three cheers for adopting a lower-sodium diet!

What about after the study was over? Could participants keep up their lower-sodium diets? The TOHP researchers wanted to find that out as well, so they provided participants with counseling and education about salt and blood pressure at intervals stretched out over a period of 18 to 48 months, with the most intensive efforts made during the first 3 months. Although the first 6 months looked promising, by 36 months, the results were pretty minimal, and it was clear that a lot of the test subjects had slacked off.

Nevertheless, at the 10- to 15-year mark, the people who had been educated on a lower-salt diet were 25 percent less likely to have developed cardiovascular disease, and 20 percent were less likely to have died, compared to people who hadn’t received the counseling. Not surprisingly, those who more consistently stuck with the lower-sodium plan were even less likely to have developed heart problems.

Also, 10 years or more out, many of these study individuals favored less-salty foods than those who hadn’t gone through the counseling program. In fact, they were more likely to choose foods low in sodium, even without a dietitian breathing down their necks.

The lesson here is that cutting salt doesn’t have to hurt. And over the long haul, it could save your life. Although many people find it hard at first to step away from the salt, human taste buds are able to adapt to a lower-sodium diet. By 3 months, less-salty foods usually taste normal again. In fact, fresh food often tastes better because the other, more subtle flavors are allowed to shine. So put down that salt shaker, stop eating overly processed packaged foods, and start enjoying the bevy of fresh and wholesome-tasting foods that are part of the DASH diet.