Blood Pressure Responses of White Men With Hypertension to Two Low-Sodium Metabolic Diets With Different Levels of Dietary Calcium

Abstract

Objective To compare the blood pressure responses of men with hypertension consuming low-sodium (Na) metabolic diets differing in dietary calcium (Ca) for two 6-week periods. Subjects White men who had hypertension, were nonsmokers, and were sedentary. Intervention This study consisted of two separate 6-week metabolic feeding periods. In the first period, a high-Ca group (n=6) was fed 1,400 mg Ca per day. In the second period, a low-Ca group (n=5) was fed 400 mg Ca per day. Both groups were fed 1,500 mg Na per day. Main outcome measures Blood pressure; urine and blood measured for electrolyte, calcitriol, renin, and parathyroid hormone (PTH) levels. To measure typical nutrient intakes, 3-day dietary records were collected before the beginning of each treatment period. Statistical analyses performed Repeated-measures analysis of variance and split-plot analysis of variance were used to analyze, respectively, blood pressure responses and response variables over time. Results In both groups, serum Na level decreased ( P<.05) over the 6-week period; urine Na decreased ( P<.05) only in the low-Ca group. Serum PTH level decreased ( P<.05) in the high-Ca group and increased ( P<.05) in the low-Ca group; no change occurred in serum calcitriol level. Diastolic blood pressure decreased (8 mm Hg) in the low-Ca group ( P<.05). The low-Ca group showed an 8% to 9% decrease in both systolic and diastolic blood pressure vs a 2% to 3% decrease in the high-Ca group. We also examined how the metabolic diet differed from subjects’ typical diet. Results showed a positive correlation between the change in Na intake (usual to metabolic diet) and the change in systolic and diastolic blood pressure in both groups ( P<.04). Results also showed a negative correlation between the change in the ratio of Na to Ca (usual to metabolic diet) and the change in diastolic blood pressure in the low-Ca group ( P<.03). Directional change in blood pressure (either increase or decrease) could be predicted on the basis of how much the Na and Ca in the metabolic diet differed from subject's typical diet. Applications Results of this study suggest that in the dietary management of hypertension it may be more important to focus on specific changes in a person's diet (eg, decreasing Na intake by 1,000 mg/day and increasing Ca intake by 400 mg/day) rather than setting specific levels of Na and Ca to be consumed. J Am Diet Assoc. 1995; 95:1280-1287.