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The effects of weight loss and salt reduction on visit-to-visit blood pressure variability: results from a multicenter randomized controlled trial

Diaz, Keith M.a,b; Muntner, Paulc; Levitan, Emily B.c; Brown, Michael D.d; Babbitt, Dianne M.b; Shimbo, Daichia

doi: 10.1097/HJH.0000000000000080
ORIGINAL PAPERS: Overweight and obesity

Objectives: As evidence suggests visit-to-visit variability (VVV) of blood pressure (BP) is associated with cardiovascular events and mortality, there is increasing interest in identifying interventions that reduce VVV of BP. We investigated the effects of weight loss and sodium reduction, alone or in combination, on VVV of BP in participants enrolled in phase II of the Trials of Hypertension Prevention.

Methods: BP readings were taken at 6-month intervals for 36 months in 1820 participants with high-normal DBP who were randomized to weight loss, sodium reduction, combination (weight loss and sodium reduction), or usual care groups. VVV of BP was defined as the SD of BP across six follow-up visits.

Results: VVV of SBP was not significantly different between participants randomized to the weight loss (7.2 ± 3.1 mmHg), sodium reduction (7.1 ± 3.0 mmHg), or combined (6.9 ± 2.9 mmHg) intervention groups vs. the usual care group (6.9 ± 2.9 mmHg). In a fully adjusted model, no difference (0.0 ± 0.2 mmHg) in VVV of SBP was present between individuals who successfully maintained their weight loss vs. individuals who did not lose weight during follow-up (P = 0.93). Also, those who maintained a reduced sodium intake throughout follow-up did not have lower VVV of SBP compared to those who did not reduce their sodium intake (0.1 ± 0.3 mmHg; P = 0.77). Results were similar for VVV of DBP.

Conclusions: These findings suggest that weight loss and sodium reduction may not be effective interventions for lowering VVV of BP in individuals with high-normal DBP.

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aCenter for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York

bHypertension, Molecular, and Applied Physiology Laboratory, Department of Kinesiology, Temple University, Philadelphia, Pennsylvania

cDepartment of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama

dVascular Health Laboratory, Department of Kinesiology & Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA

Correspondence to Keith M. Diaz, PhD, Columbia University Medical Center, 622 West 168th Street, PH 9-319, NY 10032, USA.Tel: +1 212 304 5231; fax: +1 212 305 3172; e-mail:

Abbreviations: ANCOVA, analysis of covariance; ANOVA, analysis of variance; BP, blood pressure; HR, heart rate; TOHP II, phase II of the Trials of Hypertension Prevention; VVV, visit-to-visit variability; VVV18mo, VVV calculated over three visits during the 18-month follow-up period; VVV36mo, VVV calculated over three visits during the 36-month follow-up period; VVVbaseline, VVV calculated over three visits during the baseline period; VVVFU, VVV calculated over six visits from the 6-month through the 36-month follow-up visits

Received 10 May, 2013

Accepted 20 November, 2013

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© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins