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2015 HSR&D/QUERI National Conference Abstract

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3058 — Effect of a Tailored Behavioral Intervention to Lower Sodium Intake in Veterans with Repeated Uncontrolled Hypertension

Stadler G, VA New York Harbor Healthcare System, New York, NY; Columbia University Mailman School of Public Health, New York, NY; Yeh M, VA New York Harbor Healthcare System, New York, NY; Hunter College, CUNY School of Public Health, New York, NY; Friedberg JP, VA New York Harbor Healthcare System, New York, NY; New York University, School of Medicine, New York, NY; Laibangyang A, VA New York Harbor Healthcare System, New York, NY; Wang B, VA New York Harbor Healthcare System, New York, NY; New York University, School of Medicine, New York, NY; Natarajan S, VA New York Harbor Healthcare System, New York, NY; New York University, School of Medicine, New York, NY;

Objectives:
Diet is a key non-pharmacological approach to lowering BP. An appropriate diet is equivalent to 1 BP-lowering drug and maybe 2 if combined with exercise and weight lowering. However, it is difficult to accurately assess diet. We recently demonstrated that a tailored behavioral intervention leads to lower BP (Hypertension, 2015). In the context of that trial, we evaluated if sodium intake was lowered by calculating the urine sodium-to-creatinine ratio.

Methods:
This trial evaluated the effectiveness of two active interventions, each compared to usual care (UC). Participants in the active intervention groups received either a Transtheoretical Model-based stage-matched intervention (SMI) or a non-tailored health education intervention (HEI) aimed at lowering BP through six monthly telephone calls targeting diet, exercise and medication adherence. Participants were veterans with repeated uncontrolled BP. Urinary sodium levels were measured at baseline and post-intervention (6 months). We indexed sodium intake using urinary sodium-to-creatinine ratio to standardize for time and urine volume since last urination. To compare the two intervention groups with the UC group at the 6-month follow-up, we conducted planned contrasts comparing SMI and HEI with UC in a robust regression model adjusting for baseline sodium-to-creatinine ratio.

Results:
We had baseline and 6-month urine measures from for 343 participants. At baseline, there were no differences between the groups. The median (IQR) sodium-to-creatinine ratio was 9.89 (5.36-14.84) for SMI, 10.94 (6.26-15.28) for HEI, and 10.35 (5.51-16.26) for UC. At the 6-month follow-up, the sodium-to-creatinine ratio was 8.37 (4.28-12.31) for SMI, 9.71 (5.89-13.42) for HEI, and 9.78 (6.31-14.00) for UC. Participants in the SMI group showed on average lower sodium-to-creatinine ratio than participants in the usual care group (SMI-UC contrast: p = .04). Participants in the HEI group did not differ from participants in the UC group (HEI-UC contrast: p = .45).

Implications:
A Transtheoretical telephone intervention leads to lower sodium intake. Such an intervention shows promise for lowering sodium intake in adults with uncontrolled hypertension.

Impacts:
The importance of diet, a nonpharmacological hypertension treatment, has been underemphasized. This study demonstrated that a tailored intervention effectively improves diet and can be monitored using a simple urine test.