Sodium restriction added additional blood pressure lowering to the DASH diet. Sodium restriction was more effective with increasing age and more effective than KU-57788 ic50 increasing fruit and vegetable content. The DASH diet is recognized as one of the most important non-pharmacological measures for managing blood pressure. The PREMIER study33 was a multicentre randomized trial, involving 810 adults with hypertension but not taking antihypertensive medications, which provided level II evidence that lifestyle changes, including weight loss, increased physical activity, a sodium-restricted diet and limited

alcohol consumption, can lead to significant reductions in blood pressure, with or without adherence to the DASH diet (described above). This study found that once a sodium restriction is achieved and exercise and weight loss goals are reached, adding the DASH diet had additional benefit with respect to blood pressure but, in contrast to the DASH study R428 findings, this was only the case for those over

50 years of age. Nevertheless, those who followed the DASH diet had significantly higher intakes of fibre, folate and certain minerals. A review of the evidence in the general population suggests that reducing dietary sodium and/or increasing dietary potassium is associated with a clinically significant fall in systolic blood pressure for both normotensive and hypertensive individuals. There is evidence that high sodium diets are associated with increased stroke incidence, and mortality from coronary heart disease and cardiovascular disease whereas high potassium diets are associated with decreased stroke and cardiovascular disease mortality. An upper limit of 6 g salt (2300 mg sodium)/day has been set by NHMRC but estimates suggest that reducing salt to as low as

3 g salt/day would confer benefits on blood pressure.31 An important finding of the PREMIER trial was that intensive behavioural interventions AZD9291 chemical structure (14 group sessions and four individual sessions in the first 6 months, with monthly group sessions and three individual sessions during months 7–18) versus ‘advice only’ (two individual sessions at the start of the study and at 6 months) effected significantly greater changes to diet and physical activity, and a more significant decrease in weight and blood pressure.33 A sodium-restricted diet (80–100 mmol/day) has been shown to lower the blood pressure in kidney transplant recipients. There is evidence that the blood-pressure lowering effect of a sodium restriction is more likely to occur in cyclosporine-treated patients compared with those treated with azathioprine. There are no studies that have examined the potential for adverse effects to be associated with restricted sodium intake in kidney transplant recipients.