Reduction of dietary salt intake to control systolic blood pressure in hypertensive older patients: the REPRESS randomized controlled trial.

Hypertension is the largest contributor to the global burden of cardiovascular disease and related mortality. In 2019, it was estimated to affect over 1.2 billion adults, accounting for 10.8 million deaths worldwide. The prevalence of hypertension increases with aging, affecting approximately 60% of 60 years or older people. Isolated systolic hypertension (systolic BP≥140 mmHg), is the most frequent pattern of BP in the older population. Despite effective antihypertensive drugs available, BP control remains poor, with about 50% of older patients not achieving the BP targets. Since malnutrition refers to “excesses in nutrient intake or impaired nutrient utilization”, this population could benefit of dietary interventions. Indeed, salt intake is among major dietary risk factors for hypertension and the World Health Organization considered salt restriction among the most impactful and cost-effective strategies to improve public health and looked at the long-term goal of 5 g/day by 2030.

REPRESS is an open label pragmatic randomized controlled trial with blinded endpoint, designed to assess whether a low-cost intervention aimed at reducing dietary salt intake in elderly people with uncontrolled blood pressure is more effective in improving BP control compared to a control arm. Participants will be patients aged 60 years or more with a diagnosis of isolated systolic hypertension (≥130, if treated, or ≥140, if untreated, and ≤160 mmHg), exposed to polypharmacy, prescribed or not with antihypertensives, but not adequately responding to the pharmacological treatment. Enrolled patients will be randomly assigned to two parallel arms (A: intervention and B: control). Patients randomized to the intervention arm will receive once a week on their smartphone and/or via e-mail, information materials such as videos, recipes and images, designed to sensitize them to reduce the daily dietary salt intake. 

• Promotion of an educational campaign, aimed at lowering salt intake in older patients with malnutrition.

• Promotion of patients’ awareness about the need to adopt healthy dietary and lifestyle habits.

• Improvement of older patients’ nutritional status and clinical outcomes, especially related to non-communicable diseases.

• Decrease in the pharmacological burden and related potential risks in the older population exposed to polypharmacy.

• Decrease in the carbon footprint of pharmacological drug therapies and healthcare system.

• Decrease in unnecessary National Health Service costs.