A factorial study of salt restriction and a low-fat/high-fibre diet in hypertensive subjects

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Objective:To compare the independent and additive effects of sodium restriction and a low-fat, high polyunsaturated: saturated fatty acids (P:S) ratio, high-fibre diet upon blood pressure.Design:A randomized, parallet, double-blind, placebo-controlled (for sodium) 2x2 factorial trial.Setting:Clinical.Participants:Ninety-five hypertensive subjects (mean blood pressure, 137/83 mmHg), mean age 53.5 years, consuming<30 ml ethanol/day were selected from community volunteers. Sevevty-nine treated and twelve untreated hypertensives completed the trial.Intervention:Subjects followed either a low-sodium, low-fat/high-fibre diet (<60mmol sodium/day; 30% fat energy; P:S ratio=1; 30-50g fibre/day) or a low-sodium, normal-fat/normal-fibre diet (<60 mmol sodium/day; 40% fat energy; P:S ratio=0.3; 15 g fibre/day) for 8 weeks. Half of each group received 100 mmol/day NaCI and the remainder received placebo.Main outcome measures:Blood pressure and blood lipids.Results:Sodium restriction significantly reduced standing and supine systolic blood pressure, with no effect upon diastolic blood pressure. The low-fat/high-fibre diet had no effect upon blood pressure, but significantly reduced total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol.Conclusions:Sodium restriction reduced blood pressure and did not raise low-density lipoprotein cholesterol. A low-fat/high-fibre diet did not reduce blood pressure but lowered cholesterol levels. A combination of the two regimes has the greater potential for reducing cardiovascular risk in hypertensives.

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