Multiple lifestyle changes are sustainable, can control BP.(Clinical Rounds)

People with prehypertension and hypertension can make and sustain multiple lifestyle modifications, controlling their blood pressure and perhaps reducing their risk for many chronic diseases, according to Patricia J. Elmer, Ph.D., of Kaiser Permanente Northwest's center for health research, Portland, Ore., and her associates.

They reported the results at 18-month follow-up of a randomized, multicenter study of middle-aged people. The study, funded by the National Heart, Lung, and Blood Institute, enrolled 810 subjects across the country with a systolic blood pressure of 120-159 mm Hg and a diastolic blood pressure of 80-95 mm Hg.

Almost all study participants were overweight or obese, 62% were women, and 34% were African American.

One subject group (268 people) received a behavioral intervention including advice to lose at least 15 pounds, perform at least 180 minutes per week of moderate-intensity physical activity, consume no more than 100 mmol per day of sodium, and drink no more than 1-2 alcoholic drinks per day.

A second group (269 subjects) received the same behavioral intervention plus additional advice to follow the DASH (Dietary Approaches to Stop Hypertension) diet, increasing their consumption of fruits, vegetables, and low-fat dairy products and decreasing their intake of total fat and saturated fat.

Both intervention groups kept food diaries, monitored their calorie and sodium intakes, and recorded minutes of physical activity.

In both groups, the subjects attended 14 group and four individual counseling sessions for the first 6 months, then attended monthly group sessions supplemented with three individual counseling sessions for the following 12 months. At these sessions, counseling focused on self-monitoring, reinforcement, and problem-solving, and it also promoted social support and individual motivation.