Effects of Comprehensive Lifestyle Modification on Blood Pressure Control: Main Results of the PREMIER Clinical Trial

Research output: Contribution to journalArticle

Abstract

Context: Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations. Objective: To determine the effect on BP of 2 multicomponent, behavioral interventions. Design, Setting, and Participants: Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% 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 antihypertensive medications. Intervention: Participants were randomized to one of 3 intervention groups: (1) "established, " a behavioral intervention that implemented established recommendations (n = 268); (2) "established plus DASH, "which also implemented the DASH diet (n = 269); and (3) an "advice only" comparison group (n=273). Main Outcome Measures: Blood pressure measurement and hypertension status at 6 months. Results: Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P

Original languageEnglish (US)
Pages (from-to)2083-2093
Number of pages11
JournalJournal of the American Medical Association
Volume289
Issue number16
DOIs
StatePublished - Apr 23 2003

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Life Style
Clinical Trials
Blood Pressure
Hypertension
Sodium
Diet
African Americans
Vegetables
Antihypertensive Agents
Weight Loss
Fruit
Alcohols
Outcome Assessment (Health Care)
Exercise
Weights and Measures

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Effects of Comprehensive Lifestyle Modification on Blood Pressure Control: Main Results of the PREMIER Clinical Trial",
abstract = "Context: Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations. Objective: To determine the effect on BP of 2 multicomponent, behavioral interventions. Design, Setting, and Participants: Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62{\%} women; 34{\%} 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 antihypertensive medications. Intervention: Participants were randomized to one of 3 intervention groups: (1) {"}established, {"} a behavioral intervention that implemented established recommendations (n = 268); (2) {"}established plus DASH, {"}which also implemented the DASH diet (n = 269); and (3) an {"}advice only{"} comparison group (n=273). Main Outcome Measures: Blood pressure measurement and hypertension status at 6 months. Results: Both behavioral interventions significantly reduced weight, improved fitness, and lowered sodium intake. The established plus DASH intervention also increased fruit, vegetable, and dairy intake. Across the groups, gradients in BP and hypertensive status were evident. After subtracting change in advice only, the mean net reduction in systolic BP was 3.7 mm Hg (P",
author = "Lawrence Appel",
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