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Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial.

Abstract

CONTEXT

Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations.

OBJECTIVE

To determine the effect on BP of 2 multicomponent, behavioral interventions.

DESIGN, SETTING, AND PARTICIPANTS

Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications.

INTERVENTION

Participants were randomized to one of 3 intervention groups: (1) "established," a behavioral intervention that implemented established recommendations (n = 268); (2) "established plus DASH,"which also implemented the DASH diet (n = 269); and (3) an "advice only" comparison group (n = 273).

MAIN OUTCOME MEASURES

Blood pressure measurement and hypertension status at 6 months.

RESULTS

Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P<.001) in the established group and 4.3 mm Hg (P<.001) in the established plus DASH group; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg (P =.43). Compared with the baseline hypertension prevalence of 38%, the prevalence at 6 months was 26% in the advice only group, 17% in the established group (P =.01 compared with the advice only group), and 12% in the established plus DASH group (P<.001 compared with the advice only group; P =.12 compared with the established group). The prevalence of optimal BP (<120 mm Hg systolic and <80 mm Hg diastolic) was 19% in the advice only group, 30% in the established group (P =.005 compared with the advice only group), and 35% in the established plus DASH group (P<.001 compared with the advice only group; P =.24 compared with the established group).

CONCLUSION

Individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md 21205-2233, USA. lappel@jhmi.edu

    , , , , , , , , , , ,

    Source

    JAMA 289:16 pg 2083-93

    MeSH

    Adult
    Alcohol Drinking
    Blood Pressure
    Cardiovascular Diseases
    Diet
    Diet, Sodium-Restricted
    Exercise
    Female
    Health Behavior
    Humans
    Hypertension
    Life Style
    Male
    Middle Aged
    Patient Education as Topic
    Risk Factors
    Weight Loss

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12709466

    Citation

    Appel, Lawrence J., et al. "Effects of Comprehensive Lifestyle Modification On Blood Pressure Control: Main Results of the PREMIER Clinical Trial." JAMA, vol. 289, no. 16, 2003, pp. 2083-93.
    Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289(16):2083-93.
    Appel, L. J., Champagne, C. M., Harsha, D. W., Cooper, L. S., Obarzanek, E., Elmer, P. J., ... Young, D. R. (2003). Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA, 289(16), pp. 2083-93.
    Appel LJ, et al. Effects of Comprehensive Lifestyle Modification On Blood Pressure Control: Main Results of the PREMIER Clinical Trial. JAMA. 2003;289(16):2083-93. PubMed PMID: 12709466.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. AU - Appel,Lawrence J, AU - Champagne,Catherine M, AU - Harsha,David W, AU - Cooper,Lawton S, AU - Obarzanek,Eva, AU - Elmer,Patricia J, AU - Stevens,Victor J, AU - Vollmer,William M, AU - Lin,Pao-Hwa, AU - Svetkey,Laura P, AU - Stedman,Sarah W, AU - Young,Deborah R, AU - ,, PY - 2003/4/24/pubmed PY - 2003/5/7/medline PY - 2003/4/24/entrez SP - 2083 EP - 93 JF - JAMA JO - JAMA VL - 289 IS - 16 N2 - CONTEXT: Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations. OBJECTIVE: To determine the effect on BP of 2 multicomponent, behavioral interventions. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications. INTERVENTION: Participants were randomized to one of 3 intervention groups: (1) "established," a behavioral intervention that implemented established recommendations (n = 268); (2) "established plus DASH,"which also implemented the DASH diet (n = 269); and (3) an "advice only" comparison group (n = 273). MAIN OUTCOME MEASURES: Blood pressure measurement and hypertension status at 6 months. RESULTS: Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P<.001) in the established group and 4.3 mm Hg (P<.001) in the established plus DASH group; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg (P =.43). Compared with the baseline hypertension prevalence of 38%, the prevalence at 6 months was 26% in the advice only group, 17% in the established group (P =.01 compared with the advice only group), and 12% in the established plus DASH group (P<.001 compared with the advice only group; P =.12 compared with the established group). The prevalence of optimal BP (<120 mm Hg systolic and <80 mm Hg diastolic) was 19% in the advice only group, 30% in the established group (P =.005 compared with the advice only group), and 35% in the established plus DASH group (P<.001 compared with the advice only group; P =.24 compared with the established group). CONCLUSION: Individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/12709466/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/289/pg/2083 DB - PRIME DP - Unbound Medicine ER -