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Lifestyle Changes that Lower Blood Pressure Can Reduce the Risk of Cardiovascular Disease

Released: Wednesday, April 23, 2003

Patients with high blood pressure and stage 1 hypertension who make lifestyle changes to lower their blood pressure also reduce the risk of developing cardiovascular disease, according to an article in the April 23/30 issue of The Journal of the American Medical Association (JAMA).

The article is based on a study, called “PREMIER: Lifestyle Changes for Blood Pressure Control,” conducted at four clinical centers, including the Pennington Biomedical Research Center at LSU. Other centers are Duke Medical Center, Johns Hopkins Medical Center, and the data coordinating center, Kaiser Permanente Center for Health Research.

The study demonstrates that an all-in-one approach to lifestyle changes, including a host of behavioral steps, have been proven to reduce blood pressure, lowering the patient’s risk for heart disease and stroke. According to the researchers, the best results were obtained when lifestyle changes included adoption of the DASH diet, which is rich in fruits, vegetables, and low-fat dairy products.

According to Dr. David Harsha, associate professor in the division of Nutrition and Epidemiology at the Pennington Biomedical Research Center, high blood pressure (BP) is a risk factor for cardiovascular disease (CVD). Almost 50 million U.S. adults (approximately 25 percent of the U.S. adult population) have hypertension, defined as a BP of 140/90 millimeters of mercury (mm/Hg) or higher and/or currently use anti-hypertensive (BP-lowering) medication. Hypertension risk increases with age, and approximately half of all people aged 60 or older have hypertension, and the estimated lifetime risk for developing hypertension is 90 percent.

Lifestyle modifications that lower BP are weight loss, reduced salt intake, increased physical activity, limited alcohol consumption and a balanced diet, especially the Dietary Approaches to Stop Hypertension or DASH diet which emphasizes eating fruits, vegetables, low-fat dairy products, whole grains, poultry, fish and nuts and is reduced in fats, red meats and sweets.

According to Dr. Harsha, principal investigator for the PREMIER study at Pennington, the researchers studied 810 adults (average age, 50 years old; 62 percent women; 34 percent 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 anti-hypertensive medications. Patients who participated in this randomized trial were enrolled at one of the four clinical centers from January 2000 to June 2001, and were randomly assigned to one of 3 groups: "established," a behavioral intervention that used established recommendations for lifestyle changes for lowering BP (n=268), "established plus DASH" which also used the DASH diet (n=269), and an "advice only" comparison group (n=273).

The researchers found that both of the behavioral interventions significantly reduced weight, increased fitness levels, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable and dairy intake. From baseline to six months, the mean reduction in systolic BP (the top number in blood pressure) were 6.6 mm Hg in the advice only group, 10.5 mm Hg in the established group, and 11.1 mm Hg in the established plus DASH diet group.

Compared with the 38 percent prevalence of hypertension at the beginning of the study, the prevalence at 6 months was 26 percent in the advice only group, 17 percent in the established group, and 12 percent in the established plus DASH group. The prevalence of optimal BP (less than 120 mm/Hg systolic, and less than 80 mm/Hg diastolic) was 19 percent in the advice only group, 30 percent in the established group, and 35 percent in the established plus DASH group.

Dr. Harsha added that, in summary, the trial results demonstrate the feasibility of comprehensive behavioral interventions and their beneficial effects on BP and hypertension control. "Benefits extend to both non-hypertensive individuals at risk for developing hypertension and hypertensive individuals who are not receiving medication therapy."

"Ultimately, population-wide adoption of healthy lifestyles as promoted in the PREMIER interventions should substantially reduce the societal burden of cardiovascular disease and other chronic diseases."

Also, participating in the Pennington Biomedical Research Center clinical study were Catherine Champagne PhD, Phillip Brantley, PhD, Betty Kennedy, PhD, and Erma Levy MS, LD, Interventionist.

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The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the causes of obesity, diabetes, cardiovascular disease, cancer and dementia. Itis a campus of the Louisiana State University System and conducts basic, clinical and population research. The research enterprise at the Center includes approximately 80 faculty and more than 25 post-doctoral fellows who comprise a network of 50 laboratories supported by lab technicians, nurses, dieticians, and support personnel, and 19 highly specialized core service facilities.  The Center's more than 500 employees perform research activities in state-of-the-art facilities on the 234-acre campus located in Baton Rouge, Louisiana.