Do compensatory dietary changes while reducing sodium intake lead to worse overall diet in veterans with uncontrolled blood pressure (BP)?

Background: Dietary advice to lower BP focuses on reducing sodium consumption as part of the Dietary Approaches to Stop Hypertension (DASH) diet. Sodium enhances dietary palatability; reducing intake could increase consumption of non-sodium, yet unhealthy foods. To explore this, we evaluated changes in diet related to lowering sodium in veterans with uncontrolled BP. Study Design: We analyzed 6-month longitudinal data from hypertensive veterans in a randomized trial to lower BP. We evaluated the effect of a stage-matched intervention (SMI; n=80), a health education intervention (HEI; n=79) or usual care (UC; n=75) on change in sodium consumption and other DASH diet components using robust regression analysis, as dietary data are not normally distributed. We adjusted for age, race, education, total calories, and body mass index. Results: Mean sodium intake at baseline was 1752.6 mg/day. Mean sodium change for SMI was -8.6 mg/day, HEI -79.4 mg/day, and UC +76.5 mg/day. Reducing sodium consumption was associated with reduced fiber (p<0.0001) and whole grain consumption (p<0.005) for SMI; reduced total fat consumption (p<0.05) for HEI; and reduced saturated fat (p=0.01), total fat (p<0.05), low-fat milk (p<0.05), and whole grain consumption (p=0.001), and increased sweets consumption (p=0.0005) for UC. Discussion: While sodium intake appears under-reported, the HEI group had the most success in lowering intake, and reported no adverse dietary changes. Both SMI and HEI had lower sodium intake than UC emphasizing the benefits of advice to lower dietary sodium. Further, these findings give providers additional areas to focus on while advising sodium restriction.