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Making longer-term lifestyle changes lowers rates of high blood pressure and risk of heart disease

What's New - Reducing Blood Pressure

Making Multiple Lifestyle Changes Significantly Reduces Blood Pressure, New Study Finds

(PORTLAND, Ore.) - People who make multiple changes in their health behavior can significantly reduce their blood pressure and lower their risk of heart disease and stroke. Results of a new study called PREMIER show that people who made the greatest number of lifestyle changes - including losing weight, adopting a heart-healthy eating plan known as the DASH diet, reducing salt and other forms of sodium, increasing physical activity, and limiting alcohol consumption - had the greatest reduction in blood pressure (on average, a drop of 11.1 mm Hg in systolic blood pressure and a drop of 6.4 mm Hg in diastolic.) People who made all these changes also had the greatest weight loss - 13 pounds on average. Results of the study appear in the April 23, 2003 issue of the Journal of the American Medical Association

"Fifty million Americans have high blood pressure," says Victor Stevens, Ph.D., a co-author of the article and a senior investigator at Kaiser Permanente's Center for Health Research (CHR). "Another 50 million have higher than optimal blood pressure. The PREMIER results show that people can make a number of lifestyle changes at the same time and that making these changes lowers blood pressure as much as a single medication can achieve."

"These results are wonderful news," says Patricia Elmer, Ph.D., also a co-author and senior investigator at CHR. "Millions of people with 'high-normal' blood pressure may be able to prevent hypertension without using drugs, and millions of others who have mild hypertension may be able to get their blood pressure under control through diet and exercise alone. This offers real hope for lowering the rates of heart disease and stroke in this country."

The study

PREMIER, which is funded by the National Heart, Lung, and Blood Institute, began in 1998 and was conducted at four clinical centers - CHR, Duke University, Johns Hopkins University, and Pennington Biomedical at Louisiana State University. CHR also served as the study's coordinating center. The study included 810 participants - including 228 at CHR - with blood pressures ranging from 120-159 mm Hg systolic and 80-95 mm Hg diastolic (high-normal blood pressure is 120-139/80-89 and stage 1 hypertension is 140-159/90-99). At the start of the study, 38 percent of the participants had hypertension, and most were overweight and sedentary. Sixty-two percent were women, and 34 percent were African American.

Participants were randomly assigned to one of three groups - Advice-Only, Established, and Established Plus DASH. Everyone received printed materials about blood pressure and lifestyle. Those in the Advice-Only group also received a 30-minute individual session with a nutritionist that did not include counseling on how to make behavior changes. Those in the Established group had 18 counseling sessions over six months (14 group meetings and four individual sessions). They kept track of their diet, including calorie and sodium consumption, and their physical activity. Those in the Established Plus DASH group had the same intervention program as those in the Established group but were also taught to follow the DASH diet and to record their daily servings of fruits, vegetables, dairy products, and fat.

The results

The main outcome for PREMIER was blood pressure reduction. After six months, blood pressure levels had declined in all three groups, but the reduction was significantly greater in the two intervention groups and most in the Established Plus DASH group. Systolic blood pressure decreased on average by 6.6 mm Hg in the Advice-Only group, by 10.5 in the Established group, and by 11.1 in the Established Plus DASH group. Diastolic blood pressure decreased on average by, respectively, 3.8 mm Hg, 5.5 mm Hg, and 6.4 mm Hg.

Other key results include:

• Percent of participants with hypertension whose blood pressure dropped after six months: 38 to 26 percent (Advice-Only), 37 to 17 percent (Established), and 37 to 12 percent (Established Plus DASH).
  
• Percent of participants with hypertension who were able to control their blood pressure (i.e., achieve levels below 140/90): 48 percent (Advice-Only), 66 percent (Established), and 77 percent (Established Plus DASH). By comparison, drug treatment typically controls blood pressure in about 50 percent of people with stage 1 hypertension.
  
• Optimal blood pressure (under 120/80) was achieved by 19 percent of people in Advice-Only group, 30 percent in Established group, and 35 percent in Established Plus DASH group.
  
• Percent of participants who developed hypertension: 11 percent (Advice-Only), 8 percent (Established), and 6 percent (Established Plus DASH).
  
• Average weight loss: three pounds (Advice-Only), 11 pounds (Established), and 13 pounds (Established Plus DASH).
  
• Percent of participants who reduced their intake of saturated and total fat: 44 percent (Advice-Only), 61 percent (Established), and 79 percent (Established Plus DASH).
  
• Consumption of nine or more servings per day of fruits and vegetables: six percent (Advice-Only and Established), 33 percent (Established Plus DASH).
  
• Consumption of two or more servings per day of low-fat dairy products: 34 percent (Advice-Only), 28 percent (Established), and 59 percent (Established Plus DASH).
  

Kaiser Permanente's Center for Health Research, founded in 1964, is a not-for-profit research institution that conducts research in the public domain. Its mission is "to advance knowledge to improve health." Kaiser Permanente Northwest is a group practice health care organization serving the health care needs of more than 450,000 people in Northwest Oregon and Southwest Washington.

For more infomation contact:
Terry Fitzpatrick (503) 335-6602 or
Jim Gersbach (503) 831-4820

Released: April 22, 2003