Men and women with elevated blood pressure who make healthy lifestyle changes and sustain them for up to a year and a half can substantially reduce their rates of high blood pressure and potentially decrease their heart disease risk. With behavioral counseling, increases in physical activity, and adoption of a healthy eating plan called DASH, rates of high blood pressure dropped from 37 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 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,? said 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 4 individual sessions. During the last 12 months they attended 12 group meetings and 3 individual sessions. They were prescribed goals for weight loss, physical activity, and given sodium and alcohol intake limits. One of these groups also received guidance on implementing the Dietary Approaches to Stop Hypertension diet (DASH), an eating plan rich in fruits and vegetables, low-fat dairy products and low in saturated, total fat and dietary cholesterol. DASH is used as an example of a healthy eating plan by the U.S. Dietary Guidelines for Americans, and has been shown to lower blood pressure in previous NHLBI 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 6 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. While approximately 37 percent of participants in all three groups had high blood pressure at the study?s start, this was reduced to 22 percent in the group following DASH and 24 percent in the intervention group without DASH. By comparison, the rate of hypertension fell only to 32 percent in the control group.
?Participants in the two intervention groups made greater changes than those in the control group and saw the greatest benefit in blood pressure status,? said Eva Obarzanek, Ph.D., research nutritionist and study co-author. ?This shows that people at risk for heart disease can successfully and simultaneously make multiple changes in lifestyle, for a substantial benefit.?