To the Editor.
—I read the article by Nugent et al1 with great interest, because my colleagues and I have been conducting research on sodium restriction in ambulatory hypertensive patients and their families. The identification of an effective method for helping hypertensive patients reduce their sodium intake and to maintain that reduction is important. Unfortunately, the study reported by Nugent et al has methodological flaws that weaken its conclusions. The subtitle of the article suggests that the methods being compared are "advice, education, and group management." It should be called "advice, education, and group management with intensive urine monitoring and performance feedback." The third condition confounded "group problem solving" with well-known compliance-enhancing techniques, such as repeated monitoring and performance feedback.2 The fact that the third group outperformed the others tells us nothing about the comparison of advice, education, and group management. Had the other two groups of patients
Cohen SJ. Salt Restriction in Hypertensive Patients. Arch Intern Med. 1985;145(1):179. doi:10.1001/archinte.1985.00360010227046