Evidence map›Paper›PMID 9515998›Full record

Trial reportJAMA1998

Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group.

P K Whelton, L J Appel, M A Espeland, W B Applegate, W H Ettinger, J B Kostis, S Kumanyika, C R Lacy, K C Johnson, S Folmar and 1 more

Erratum issued 3 registry-linked trialsAbstract readClinical TrialRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in JAMA, 1998. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 3 registered trials, which are not on this map. Cited by 356 papers, 31 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
356citing papers in PubMed, 31 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06948825 phase2recruitingstarted 2025, after this paper: background citation

Effectiveness Study of a Lifestyle Intervention Versus Metformin in Mothers With Recent Gestational Diabetes

Ran2025Enrolled60Registered outcomes12Posted comparisons0ConditionsGestational Diabetes Mellitus in Pregnancy, Postpartum Care, Weight LossArmsEnhanced Lifestyle Intervention, Lifestyle Intervention, Metformin Hcl 850Mg Tab
PMID 26840133PMID 11832527PMID 12436333PMID 11333990PMID 11547793PMID 12545145PMID 15932841PMID 16936160PMID 17596462PMID 18463375PMID 19461459PMID 19465232other papers from this trial
Open the trial in the graph
NCT00000535 phase3completednot on this map

Trial of Nonpharmacologic Interventions in Elderly (TONE)

TypeinterventionalSponsorNational Heart, Lung, and Blood Institute (NHLBI)Ran1992 to 1997ConditionsCardiovascular Diseases, Heart Diseases, Hypertension, Vascular DiseasesArmsdiet, reducing, diet, sodium-restricted
NCT02451670 nacompletednot on this mapstarted 2016, after this paper: background citation

Reducing Cardiovascular Risk in Adults With Serious Mental Illness Using an Electronic Medical Record-based Clinical Decision Support

TypeinterventionalSponsorHealthPartners InstituteRan2016 to 2018Enrolled10,347ConditionsChronic Disease, Mental Disorder, Health Behavior, Bipolar DisorderArmsPrioritized Clinical Decision Support
3 · Its place in the literature

Who cites it

356 citing papers in PubMed, 31 syntheses or guidelines pooled it.

  1. The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Guideline
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2022
    Pooled it
  6. Pooled it
  7. Long-term effects of weight-reducing diets in people with hypertension.The Cochrane database of systematic reviews · 2021
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020
    Pooled it
  11. Effects of total fat intake on body fatness in adults.The Cochrane database of systematic reviews · 2020
    Pooled it
  12. Reduction in saturated fat intake for cardiovascular disease.The Cochrane database of systematic reviews · 2020
    Pooled it
  13. Guideline
  14. Guideline
  15. Guideline
  16. Guideline
  17. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
  18. Pooled it
  19. Pooled it
  20. Pooled it

296 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

P K WheltonDepartment of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La 70112, USA. PWHELTON@TULANE.EDU
L J Appel
M A Espeland
W B Applegate
W H Ettinger
J B Kostis
S Kumanyika
C R Lacy
K C Johnson
S Folmar
J A Cutler

Funding

DIETARY INTERVENTIONS IN THE ELDERLY TRIAL (DIET)R01AG009771 · NIA · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · PI APPLEGATE, WILLIAM B · 1992 to 1995
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DIETARY INTERVENTIONS IN THE ELDERLY TRIALR01AG009799 · NIA · WAKE FOREST UNIVERSITY · PI ETTINGER, WALTER H · 1992 to 1995
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TRIAL OF NONPHARMACOLOGIC INTERVENTIONS IN THE ELDERLYR01HL048642 · NHLBI · UNIV OF MED/DENT NJ-R W JOHNSON MED SCH · PI KOSTIS, JOHN B · 1992 to 1995
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NHLBI NIH HHS R01 HL-48642NIA NIH HHS R01 AG-09771NIA NIH HHS R01 AG-09799
6 · The paper itself

Abstract

contextNonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation.

objectiveTo determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension.

designRandomized controlled trial.

participantsA total of 975 [corrected] men and women aged 60 to 80 years with systolic blood pressure lower than 145 mm Hg and diastolic blood pressure lower than 85 mm Hg while receiving treatment with a single antihypertensive medication.

settingFour academic health centers.

interventionThe 585 obese participants were randomized to reduced sodium intake, weight loss, both, or usual care, and the 390 nonobese participants were randomized to reduced sodium intake or usual care. Withdrawal of antihypertensive medication was attempted after 3 months of intervention.

main outcome measureDiagnosis of high blood pressure at 1 or more follow-up visits, or treatment with antihypertensive medication, or a cardiovascular event during follow-up (range, 15-36 months; median, 29 months).

resultsThe combined outcome measure was less frequent among those assigned vs not assigned to reduced sodium intake (relative hazard ratio, 0.69; 95% confidence interval [CI], 0.59-0.81; P<.001) and, in obese participants, among those assigned vs not assigned to weight loss (relative hazard ratio, 0.70; 95% CI, 0.57-0.87; P<.001). Relative to usual care, hazard ratios among the obese participants were 0.60 (95% CI, 0.45-0.80; P<.001) for reduced sodium intake alone, 0.64 (95% CI, 0.49-0.85; P=.002) for weight loss alone, and 0.47 (95% CI, 0.35-0.64; P<.001) for reduced sodium intake and weight loss combined. The frequency of cardiovascular events during follow-up was similar in each of the 6 treatment groups.

conclusionReduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

Indexed as

Diet, Sodium-RestrictedWeight LossAgedAlgorithmsAnalysis of VarianceAntihypertensive AgentsFemaleFollow-Up StudiesHumansHypertensionLikelihood FunctionsMaleMiddle AgedObesityProportional Hazards ModelsSodium, DietaryAntihypertensive AgentsSodium, Dietary

Identifiers

PMID9515998

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.