***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The aim of the study was to examine the adherence to a salt restriction diet and the effect of salt restriction on blood pressure in free living subjects with mildly elevated blood pressure . Design : Subjects with mildly elevated blood pressure participated in a controlled study on the effect of salt restriction on blood pressure . Subjects received oral and written instructions by a clinical nutritionist to reduce sodium chloride intake to five grams per day . A low sodium bread ( 0.5 % ) was supplied free of charge for the subjects during the whole low-sodium period ( between weeks 4–24).Subjects and methods : Subjects were recruited from previous studies at the Kuopio Research Institute of Exercise Medicine and from local occupational health care services . Twenty-four men and 15 women aged 28–65 y with the mean daytime ambulatory diastolic blood pressure between 90–105 mmHg and office diastolic blood pressure between 95–115 mmHg were included in the study . Salt intake was monitored by 4-d food diaries and 24-h urinary sodium excretion . Results : Twenty percent of the subjects achieved a urinary sodium excretion level of less than 74 mmol/24 h corresponding to a salt intake of five grams per day . There was a significant decline ( 7.1±12.7/4.2±7.5 ) in systolic and diastolic blood pressure levels during the salt restriction diet . Conclusions : Even moderate salt restriction seems to be effective in the treatment of mildly elevated blood pressure . However , the recommended salt intake level of less than five grams per day is difficult to achieve even after intensive counselling and regular use of low salt bread . Sponsorship : F. Hoffmann-La Roche Limited Company ; The Finnish Cultural Foundation of Northern Savo , The Yrjö Jahnsson Foundation , The University of Kuopio Sodium restriction can reduce blood pressure in hypertensive patients . The present study indicates that if hypertension is well controlled then the reemergence of hypertension can be decreased by the use of a reduced sodium intake . The present paper demonstrates that in such patients on a normal salt diet  , 90 % become hypertensive within 6 months while only 40 % of people on a reduced sodium diet  become hypertensive . It is proposed that a high sodium intake activates a number of amplifiers that causes a shift of the dose-response curve to sodium to the left and if not prevented or interrupted leads to the development of hypertension The Trial of Antihypertensive Interventions and Management is a multicenter r and omized trial design ed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension ( diastolic blood pressure 90 - 100 mm Hg ) . Eight hundred and seventy-eight participants at 110 - 160 % of ideal weight were r and omly allocated to nine drug/diet treatment groups receiving either a placebo , chlorthalidone ( 25 mg ) , or atenolol ( 50 mg ) , combined with a usual , a weight loss , or a low sodium/high potassium diet The primary outcome was diastolic blood pressure change from baseline to 6 months . Seven hundred and eighty-seven participants had follow-up data . The mean baseline diastolic blood pressure  was 93.8 mm Hg ; 55.9 % of the participants were male , and the weight loss diet group lost an average of 4.7 kg . Multiple comparisons were accounted for in the analysis . A significantly greater lowering of diastolic blood pressure ( 12.4 mm Hg ) was achieved in the atenolol group compared with either the low sodium/high potassium diet group ( 7.9 mm Hg , p=0.001 ) or weight loss group ( 8.8 mm Hg , p=0.006 ) . Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering ( 15.1 mm Hg ) when compared with the diuretic alone ( 10.8 mm Hg , p=0.002 ) , but adding a low sodium/high potassium diet ( 12.2 mm Hg , p=0.029 ) did not In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration , drugs outperform diet , and weight loss is beneficial , especially with diuretics The Hypertension Prevention Trial ( HPT ) was a r and omized , controlled , multicenter ( four clinics , four re source centers ) trial design ed to test the feasibility of achieving and sustaining dietary changes in the intake of calories , sodium , and potassium and to assess the effect of those changes on blood pressure in a normotensive population . The trial involved 841 men and women ( plus a test cohort of 78 ) who , at the first baseline ( BL ) examination were in the age range of 25 - 49 years and had diastolic blood pressure ( DBP ) greater than or equal to 76 but less than 100 mm Hg ( average of two readings ) , and at the examination prior to r and omization ( BL 2 ) , had DBP greater than or equal to 78 but less than 90 mm Hg ( also averaged ) . Participants were r and omly assigned to a control treatment group ( no dietary counseling ) or to one of four dietary treatment groups involving counseling design ed to reduce calorie intake , reduce sodium intake , reduce sodium and calorie intake , and reduce sodium and increase potassium intake .  This chapter describes the process of recruiting participants for the trial . Methods used to identify and contact study participants are presented . Details of the steps involved in the recruitment process and strategies for reducing costs are discussed Objective : To determine the blood pressure responses in elderly normotensive men and women to dietary sodium and to the diunsaturated fatty acid dihomogammalinolenic acid ( DGLA ) , which is derived from linoleic acid Design : Blood pressure responses were assessed in 66 subjects ( 36 male , 30 female ; mean age 65 years ) on two diets differing by approximately 70mmol/day sodium , combined with daily supplements of either 1 g DGLA or 1 g safflower oil  , giving a four-group parallel design . After a common period of salt restriction and salt supplementation , two sets of parallel groups continued with either salt or placebo tablets . The study was blinded , except for dietary adjustments based on 24-h urinary sodium excretion values measured once every 2 weeks . Blood pressures were also measured automatically once every 2 weeks Results : Urinary sodium excretion ( sodium intake ) correlated significantly with systolic and diastolic blood pressures . A strong interaction with sex ( P < 0.001 for systolic blood pressure ) reflected greater responsiveness in women to changing sodium intake . A second major determinant of blood pressure responsiveness was the waist : hip ratio , an index of central obesity ; this correlation was independent of the initial sodium intake , initial blood pressure or body mass index . The waist : hip ratio was a powerful predictor of blood pressure changes with sodium intake in women only ; women with and roid fat distribution were , similarly to men , less sensitive to dietary sodium . Daily supplements of 1 g DGLA doubled the concentration of DGLA in plasma but did not influence blood pressure Conclusions : Among elderly normotensive subjects , women responded to changes in sodium intake with greater changes in blood pressure than men did . Furthermore , this response was strongly related to the gynaecoid distribution of body Phase I of the Trials of Hypertension Prevention ( TOHP ) was a r and omized , multicenter investigation that included double-blind , placebo-controlled testing of calcium and magnesium supplementation among 698 healthy adults ( 10.5 % blacks and 31 % women ) aged 30 to 54 years with high-normal diastolic blood pressure ( DBP ) ( 80 to 89 mm Hg ) . Very high compliance ( 94 to 96 % by pill counts ) with daily doses of 1 g of calcium ( carbonate ) , 360 mg of magnesium ( diglycine ) , or placebos was corroborated for the active supplements by significant net increases in all urine and serum compliance measures in white men and for urine compliance measures in white women . Overall , neither calcium nor magnesium produced significant changes in blood pressure at 3 and 6 months . Analyses stratified by baseline intakes of calcium , magnesium , sodium , or initial blood pressures also showed no effect of supplementation . These analyses suggested that calcium supplementation may have result ed in a DBP decrease in white women and that response modifiers in this subgroup might have included lower initial urinary calcium levels , urinary sodium levels , or lower body mass index . However , overall analyses indicated that calcium and magnesium supplements are unlikely to lower blood pressure in adults with high-normal DBP . The subgroup analyses , useful to formulate hypotheses , raise the possibility of a benefit to white women , which requires testing in future trials BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4.0 % ) at 3 years , and -5.7 lb ( -3.0 % ) at 4 years . At 4 years , 70 % of participants remained below baseline weight and 34 % maintained a weight loss of 10 lb or greater . Mean change in urinary sodium excretion was -12.5 mmol/8 hr ( -23 % ) at 1 year , -10.7 mmol/8 hr ( -20 % ) at 2 years , -8.4 mmol/8 hr ( -16 % ) at 3 years , and -4.6 mmol/8 hr ( -9 % ) at 4 years . Alcohol intake declined by 1.6 drinks/week among drinkers at 4 years . Reported leisure physical activity increased by 86 % at 1 year and remained 50 % above baseline at 4 years . Beneficial changes in blood pressure and serum lipids were associated with these changes . CONCLUSIONS These results support a role for lifestyle interventions as the initial treatment for stage 1 hypertension and demonstrate that such interventions can be successfully implemented in the clinical setting BACKGROUND Cross-sectional studies on human hypertension have suggested an association between sodium intake and left ventricular hypertrophy ( LVH ) . METHODS AND RESULTS The effects on LVH of a nonpharmacological treatment program based mainly on sodium restriction were examined by serial echocardiography in a 12-month controlled , r and omized study that included 76 previously untreated subjects with uncomplicated mild-to-moderate hypertension . The mean daily sodium excretion of 38 subjects r and omized into the treatment group decreased from 195 + /- 95 to 94 + /- 73 mmol ( P < .001 ) at 6 months and to 109 + /- 74 mmol ( P < .001 ) at 12 months . This was accompanied by a weight decrease from 81.4 + /- 18.0 to 79.2 + /- 17.4 kg ( P < .001 ) at 6 months and to 80.6 + /- 17.5 kg ( NS ) at 12 months . The net blood pressure decrease ( difference in change from baseline between the treatment and control groups ) was 8.9 mm Hg ( P < .001 ) in systolic blood pressure and 6.5 mm Hg ( P < .001 ) in diastolic blood pressure during the first 6 months and 6.7 mm Hg ( P < .01 ) in systolic blood pressure and 3.8 mm Hg ( P < .01 ) in diastolic blood pressure during the last 6 months . After 12 months of sodium restriction , left ventricular mass ( LVM ) had decreased by 5.4 % ( from 238 + /- 63 to 225 + /- 51 g , P < .01 ) , and LVM index ( LVMI ) had decreased by 4.7 % ( from 123 + /- 26 to 117 + /- 22 g/m2 , P < .05 ) , whereas no changes occurred in these parameters in the control group . In treated subjects with baseline LVMI of more than the median value of 133 g/m2 in men and 107 g/m2 in women , LVM decreased by 8.6 % ( from 272 + /- 62 to 249 + /- 51 g , P < .01 ) , and LVMI decreased by 7.1 % ( from 140 + /- 23 to 130 + /- 22 g/m2 , P < .01 ) . LVM and LVMI remained unchanged in treated subjects with LVMI values equal to or less than the median . CONCLUSIONS Our data suggest that long-term nonpharmacological treatment with moderate sodium restriction decreases LVH Etude chez 12 malades atteints d'hypertension essentielle non compliquee , sans tra 
    Output:
    
People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls , while maintaining similar blood pressure control .
REVIEW ER 'S CONCLUSIONS Intensive interventions , unsuited to primary care or population prevention programmes , provide only minimal reductions in blood pressure during long-term trials .
Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives .