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

Year 2019, , 514 - 522, 20.12.2019

Ayşe Akay

https://doi.org/10.21763/tjfmpc.527288

Abstract

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.

Amaç: Önemli bir toplum sağlığı sorunu olan hipertansiyonun kontrolünde birinci
aşama, hastalarda sağlıklı yaşam tarzının sağlanmasıdır. Uygulamada tedavi
hedeflerine kısıtlı bir hasta grubunda ulaşılabilmekte, yaşam tarzı
değişiklikleri ve bunlardan beklenen yarar eksik kalmaktadır. Bu araştırmada
tıbbi tedavi altındaki primer hipertansiyon hastalarında mevcut tedavilerine
eklenecek tuz kısıtlaması danışmanlığı ile elde edilecek ek yararı belirlemek
amaçlanmıştır.Gereç-yöntem: Randomize, kontrollü desendeki çalışmaya
sabit tedavi altındaki primer hipertansiyon hastaları dâhil edildiler. Hastalar
tuz kısıtlaması ve kontrol gruplarına ayrıldılar. Tüm katılımcılara demografik
bilgileri, tıbbi öykü ayrıntıları, beslenme alışkanlıklarını sorgulayan bir
anket uygulandı. Çalışma başlangıcında ve 3 aylık çalışma süresi sonunda Holter
ile 24 saatlik ambulatuar kan basıncı ölçümü yapıldı. Tuz kısıtlaması konusunda
bireyselleştirilmiş danışmanlık görüşmesi yapıldı. Kontrol grubuna görüşme
planı verildi. Çalışma grubu hastalarının önerilere uyumu telefon görüşmeleri
ile izlendi. Tuz kısıtlaması danışmanlığının etkisi 24 saatlik idrarda
hesaplanan sodyum atılımı ile izlendi.Bulgular: Araştırmaya dahil olan toplam 172 katılımcının %71,5’i (123) kadın,
%28,5’i (49) erkek, yaş ortalamaları 56,8±5,9 yıl idi.Çalışma, tuz kısıtlaması grubunda 86 ve
kontrol grubunda 86 hipertansiyon hastası ile sonuçlandırıldı. Çalışmamızın
sonuçlarına göre üriner sodyum atılımı kontrol grubunda 1,8±5,2 gr/gün artarken
(Z=3,120; p=0,002), tuz kısıtlaması grubunda 1,0±4,9 gr/gün azaldı (Z=1,983;
p=0,047). Ambulatuar sistolik ve diyastolik kan basıncı ölçümleri 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 kısıtlaması grubunda 6,1±9,4 mm Hg (Z=5,137; p<0,001) /4,7±7,8
mm Hg düştü (Z=4,993; p<0,001).Sonuçlar: Çalışma sonuçlarımız, halen
tedavi altında olan hipertansiyon hastalarında da tuz kısıtlaması danışmanlığı
verilmesinin daha iyi kan basıncı kontrolü sağlanmasına katkı yapmakta olduğunu
gösterdi. Yaşam tarzı değişiklikleri hipertansiyon hastalarının sabit ilaç
tedavi protokollerine geçildikten sonra da etkin tedavi özelliğini
sürdürmektedir.

Keywords

ambulatory blood pressure measurements, hypertension, primary care settings, life style change, salt restriction

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