Making multiple lifestyle changes can lower high blood pressure

Men and women with elevated blood pressure who make healthy lifestyle changes and sustain them for up to a year and a half can reduce their rates of high blood pressure and decrease their heart disease risk, a new study indicates.

With behavioral counseling, increases in physical activity, and adoption of a healthy eating plan called Dietary Approaches to Stop Hypertension (DASH), rates of high blood pressure dropped from 37 percent to 22 percent among participants in a study conducted by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke. About 65 million American adults, one in three, have high blood pressure. An additional 59 million adults have prehypertension, a level that is above normal and that increases risk of heart disease and stroke.

Results of the study, called PREMIER, appear in the April 4, 2006, issue of Annals of Internal Medicine.

"This study underscores the value of lifestyle changes-namely improving diet and increasing physical activity--in reducing high blood pressure, an important public health problem," says NHLBI Director Elizabeth G. Nabel, M.D. "For the millions of Americans with prehypertension and hypertension, this shows that individuals can make healthy lifestyle changes to keep blood pressure under control without the use of medications."

A total of 810 men and women ages 25 and older with either prehypertension (120-139mmHg/80-89mmHg) or stage 1 hypertension (140-159mmHg/90-95mmHg), but who were not taking medications to control blood pressure, were randomly assigned to three groups. Participants in two of the groups attended 18 counseling sessions during the first six months--14 group meetings and four individual sessions. During the last 12 months, they attended 12 group meetings and three individual sessions. They were prescribed goals for weight loss, and physical activity, and were given sodium and alcohol intake limits.

One of these groups also received guidance on implementing DASH, which has been shown to lower blood pressure in other studies.

A third group served as a control, receiving only two 30-minute sessions of advice to follow standard recommendations for blood pressure control; one at study enrollment and one six months later. A third session was offered at the end of the 18-month trial after measurements were completed.

The numbers of participants with high blood pressure declined in all three groups, but the reduction was greater in the intervention groups and most striking in the intervention group that included the DASH eating plan. About 37 percent of participants in all three groups had high blood pressure at the study's start. The percentage was reduced to 22 percent in the group following DASH and to 24 percent in the intervention group without DASH. By comparison, the rate of hypertension fell only to 32 percent in the control group.

Ninety-five percent of the study participants were overweight or obese at the start of the study. Goals for the intervention groups included a 15-pound weight loss, three hours of moderate physical activity three times a week, daily sodium intakes of 2,300 milligrams (1 teaspoon) or less of salt, and limits of one alcoholic drink per day for women and two per day for men. Those also following the DASH diet were asked to increase their consumption of fruits and vegetables to 9-12 servings per day, consume 2-3 servings of low-fat dairy products, and keep total fat to no more than 25 percent of total daily calories.