Effects of salt restriction counseling on primary hypertension patients already receiving pharmacotherapy; A Randomized controlled trial

Background and aim: Providing a healthy lifestyle is the first stage of controlling hypertension, which is an important public health problem. However, lifestyle modification targets can only be achieved among limited patients. As a result, expected benefits from those modifications remain limited. In this research, we aimed to verify the additional gains from salt restriction counseling on blood pressure control among primary hypertensive patients already receiving pharmacotherapy. Materials and methods: Primary hypertension patients under a stable medical treatment were randomly assigned to a salt restriction group and a control group. All participants completed a questionnaire of demographic data, medical history, and diet. Twenty-four-hours ambulatory blood pressure measurements were recorded at the beginning and at the end of 3 months. Personalized education and counseling were performed only to the salt restriction group. Patients were followed up with phone calls. Effects of salt restriction were evaluated with sodium excretion on 24-hour urine. Results: Total 172 patients enrolled in the study; 86 patients were in salt restriction group and 86 patients were in control group. The patients’ 71,5% (123) were women, 28,5% (49) were men. The mean age of participants was 56,8 ±5,9 years. Urinary sodium excretion increased 1.8±5.2 g/day in the control group (Z=3,120; p=0,002) but decreased 1,0±4,9 g/day in the study group (Z=1,983; p=0,047). Ambulatory systolic and diastolic blood pressures increased 3.2±9.3/2.3±6.9 mm Hg in the control group (Z=3,165; p=0,002/Z=2,956; p=0,003), whereas they decreased 6.1±9.4/4.7±7.8 mm Hg in the salt restriction group (Z=5,137; p<0,001/Z=4,993; p<0,001). Conclusion : Our study indicates that salt restriction counseling significantly contributed to blood pressure control also in primary hypertension patients already receiving pharmacotherapy. Lifestyle modification proves to be an effective treatment in patients who receive regular medical treatment. Amac: Onemli bir toplum sagligi sorunu olan hipertansiyonun kontrolunde birinci asama, hastalarda saglikli yasam tarzinin saglanmasidir. Uygulamada tedavi hedeflerine kisitli bir hasta grubunda ulasilabilmekte, yasam tarzi degisiklikleri ve bunlardan beklenen yarar eksik kalmaktadir. Bu arastirmada tibbi tedavi altindaki primer hipertansiyon hastalarinda mevcut tedavilerine eklenecek tuz kisitlamasi danismanligi ile elde edilecek ek yarari belirlemek amaclanmistir. Gerec-yontem: Randomize, kontrollu desendeki calismaya sabit tedavi altindaki primer hipertansiyon hastalari dâhil edildiler. Hastalar tuz kisitlamasi ve kontrol gruplarina ayrildilar. Tum katilimcilara demografik bilgileri, tibbi oyku ayrintilari, beslenme aliskanliklarini sorgulayan bir anket uygulandi. Calisma baslangicinda ve 3 aylik calisma suresi sonunda Holter ile 24 saatlik ambulatuar kan basinci olcumu yapildi. Tuz kisitlamasi konusunda bireysellestirilmis danismanlik gorusmesi yapildi. Kontrol grubuna gorusme plani verildi. Calisma grubu hastalarinin onerilere uyumu telefon gorusmeleri ile izlendi. Tuz kisitlamasi danismanliginin etkisi 24 saatlik idrarda hesaplanan sodyum atilimi ile izlendi. Bulgular: Arastirmaya dahil olan toplam 172 katilimcinin %71,5’i (123) kadin, %28,5’i (49) erkek, yas ortalamalari 56,8±5,9 yil idi.Calisma, tuz kisitlamasi grubunda 86 ve kontrol grubunda 86 hipertansiyon hastasi ile sonuclandirildi . Calismamizin sonuclarina gore uriner sodyum atilimi kontrol grubunda 1,8±5,2 gr/gun artarken (Z=3,120; p=0,002), tuz kisitlamasi grubunda 1,0±4,9 gr/gun azaldi (Z=1,983; p=0,047). Ambulatuar sistolik ve diyastolik kan basinci olcumleri kontrol grubunda 3,2±9,3 mm Hg (Z=3,165; p=0,002) /2,3±6,9 mm Hg artarken (Z=2,956; p=0,003), tuz kisitlamasi grubunda 6,1±9,4 mm Hg (Z=5,137; p<0,001) /4,7±7,8 mm Hg dustu (Z=4,993; p<0,001). Sonuclar: Calisma sonuclarimiz, halen tedavi altinda olan hipertansiyon hastalarinda da tuz kisitlamasi danismanligi verilmesinin daha iyi kan basinci kontrolu saglanmasina katki yapmakta oldugunu gosterdi. Yasam tarzi degisiklikleri hipertansiyon hastalarinin sabit ilac tedavi protokollerine gecildikten sonra da etkin tedavi ozelligini surdurmektedir.