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November 13, 1996

Dietary Sodium and Blood Pressure-Reply

Author Affiliations

Mount Sinai Hospital Toronto, Ontario
Alberta Children's Hospital Calgary, Alberta

JAMA. 1996;276(18):1469-1470. doi:10.1001/jama.1996.03540180025017

In Reply.  —Our critics assert that data from RCTs, especially when pooled, must be viewed cautiously, even skeptically, when making statements that bear directly on health policy. They are particularly critical about trials with a short time horizon and allude to study selection bias. All RCTs that met our stringent eligibility criteria were included in the primary analysis, and extensive subgroup analyses were performed and reported, although, because of editorial constraints, not in the detail that both we and Dr Stamler would have desired. Dr Whelton and colleagues and Drs Kotchen and Krauss chose to ignore the point made in our article that the inclusion of short-term trials amplified the effect of dietary salt restriction. For example, excluding the short-term trials in normotensive subjects (<15 days in duration) reduced the net effect on systolic blood pressure from 1.0 mm Hg per 100 mmol/d to 0.55 mm Hg per 100 mmol/d, and the