Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure.
A low sodium diet may help in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.
Salt restriction and physical activity in treated hypertensives.
To determine the effect on blood pressure from brisk walking with or without salt restriction in a community based sample of treated hypertensives.
                The intervention was undertaken in a community setting with a factorial randomised controlled trial and blinded assessment of blood pressure. One hundred and eighty one healthy adult volunteers with a sedentary lifestyle and on pharmacological therapy for hypertension briskly walked for 40 minutes three times per week with or without salt restriction. Systolic and diastolic blood pressure were assessed at three and six months.
                Of the original 208 participants 181 (87%) completed the study. significant reductions of up to 7 mm Hg were found in systolic blood pressure at 3 months for brisk walking alone (p = 0.04) and salt restriction alone (p = 0.03) but not for the combined intervention (p = 0.17). No significant change was found for diastolic blood pressure. There was no significant change in blood pressure at 6 months.
                Simple advice on exercise and sodium restriction in a community setting can significantly lower systolic blood pressure at least for 3 months. The combination of the two interventions was less effective than each therapy alone.