Multiple lifestyle changes effectively lower blood pressure

el and colleagues followed 810 adults with elevated blood pressure at four clinical centers: Johns Hopkins; Pennington Biomedical Research Center, Baton Rouge, La.; Duke University Medical Center, Durham, N.C.; and Kaiser Permanente Center for Health Research, Portland, Ore. The average age of participants was 50. Sixty-two percent were women and 34 percent were African-American. Overall, the participants were overweight and sedentary.

PREMIER participants were assigned randomly to one of three groups. The first group had one 30-minute session with a registered dietitian offering general advice on lowering blood pressure. The second group had 18 counseling sessions over the six-month period on losing weight, reducing salt and increasing exercise but no advice on the DASH diet. A third group also had 18 sessions, but the counseling included advice on the DASH diet (as well as the counseling on exercise, weight loss and salt reduction). Those in the groups with 18 counseling sessions kept track of their physical activity and food intake.

While members of all three groups lowered blood pressure, the third group had the best results. Those in this group doubled the reduction in blood pressure compared with those in the group that received one session. The third group also was much less likely to need blood pressure medications. By six months, 19 people in the one-session group needed blood pressure drugs, compared with two people in the second group and five people in the third group.

Appel acknowledges that adopting multiple changes can sometimes be a challenge. "For people who have a hard time with this, start with one change, like exercising, and then add others as you can." Before starting or increasing their exercise, people should check with their physician, he says.

The study was supported by the National Heart, Lung and Blood Institute. Appel chaired the writing group; his co-authors were Catherine M. Champagne, Ph.D

Contact: Karen Blum
Johns Hopkins Medical Institutions

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