Behavioral Interventions Help Reduce High Blood Pressure

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Behavioral Interventions Help Reduce High Blood Pressure

Approximately one in four U.S. adults suffers from high blood pressure (defined as BP of 140/90 mm/Hg or higher and/or current use of antihypertensive medication), and more than half of U.S. adults age 60 or older are afflicted with the condition.

In fact, the estimated lifetime risk of developing high blood pressure is 90%, underscoring the need for effective treatment and prevention methods.

Weight loss, sodium reduction, increased physical activity and limited alcohol intake are established means of reducing hypertension. This study involving 810 adults with above-optimal blood pressure, including stage 1 hypertension (120-159/80-95 mm Hg), but not currently taking antihypertensive medication, evaluated the ability of two behavioral interventions to reduce BP over a six-month period.

Patients were randomized into one of three groups for comparative purposes. The first group received the established behavioral recommendations noted above (weight loss, sodium reduction, physical activity, etc.); the second group received established recommendations and adhered to the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes whole grains, fish, poultry, fruits and vegetables, and limited red meat, saturated fat and sugar intake. Members of the third group served as a comparison group, with each participant receiving "advice only" by way of a single, 30-minute session immediately following randomization.

The average participant was overweight and sedentary, with an average blood pressure reading of 134.9/84.8 mm Hg. Outcome measures included comparison of BP measurements, taken at baseline, three-month and six-month assessments; weight; nutrient intake; and cardiovascular fitness.

Blood pressure decreased over time in all three groups, but more significantly in the group receiving established recommendations and established recommendations plus the DASH diet. After accounting for BP changes in the advice-only group, the interventions lowered blood pressure by an average of 3.7/1.7 mm Hg in the established recommendations group and 4.3/2.6 mm Hg in the recommendations plus DASH diet group. Reductions in participants diagnosed with hypertension at baseline were even more dramatic, with average BP reduction of 4.6/2.0 mm Hg in the first group and 6.3/3.6 mm Hg in the second group. The authors state: "In summary, our trial results demonstrate the feasibility of comprehensive behavioral interventions and their beneficial effects on BP and hypertension control."

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control. Main results of the PREMIER Clinical Trial. Journal of the American Medical Association, April 23/30, 2003:289(16), pp2083-93.
http://jama.ama-assn.org/