Multiple Lifestyle Changes Help Lower Blood Pressure

Measures include counseling on nutrition and exercise, study reports

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By Ed Edelson
HealthDay Reporter

MONDAY, April 3, 2006 (HealthDay News) -- Offered intensive counseling, people in a major U.S. study made major lifestyle changes that helped them bring their high blood pressure down to healthy levels.

But physicians involved in the study differed on whether lessons learned in the study can be applied on a large scale in real life.

No one questions the need to fight high blood pressure, a major risk factor for heart disease and the leading risk factor for stroke. An estimated 65 million adults have outright high blood pressure and another 59 million have levels high enough to raise concern, according to the National Heart, Lung, and Blood Institute.

The study, sponsored by the institute, was relatively small, including 810 men and women with either high blood pressure (readings of more than 140/90), or levels slightly above the desired 120/80. None of the participants were taking medication for the condition.

They were divided into three groups. One group got just two 30-minute sessions of advice on the standard measures for controlling blood pressure. The second group attended 18 counseling sessions during the first six months of the study, followed by 15 sessions over the next 12 months. They were given goals for weight loss, physical activity, and salt and alcohol intake. The third group received the same counseling plus added advice on following a diet rich in fruits, vegetables and low-fat dairy products and low in total fat and cholesterol.

The number of participants with high blood pressure declined in all three groups over 18 months, but the drop was greatest in the group that got the most advice. At the start, 37 percent of all participants had high blood pressure. After 18 months, that dropped to 32 percent of those getting minimum counseling, 24 percent of those receiving intensive counseling and 22 percent of those getting counseling plus dietary advice.

The findings appear in the April 4 issue of the Annals of Internal Medicine.

To Victor J. Stevens, a senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., who was responsible for coordinating data from the study, the result was a clear success.

"This is very good news," Stevens said. "It shows that people with high blood pressure or borderline high blood pressure can reduce pressure and sustain the reduction for at least 18 months."

More than that, he said, the study showed what many have doubted -- that individuals can change many parts of their lifestyle simultaneously. "One of the things we found was that people could make these combined changes, and for a year and a half," Stevens said. "We were worried about combining all of these changes together, but we found that everyday people can deal with these complex things."

Now that there is a proof of principle, "We have to try to come up with a system that could be adopted by health-care providers," said Dr. David W. Harsha, an associate professor of nutrition and chronic disease at Louisiana State University, one center where the study was conducted.

"We have demonstrated that this is possible, and we will disseminate the information as widely as possible," Harsha said. "Perhaps it is something that government or some other institution can do."

A slight note of caution was injected by another participant, Dr. Lawrence Appel, a professor of medicine at Johns Hopkins Medical Institutions. True, "our message is that you can make multiple lifestyle changes that do have benefits in terms of blood pressure control," Appel said. But it won't be an easy thing for individuals to do on their own, he added.

"Typically, they will need some coaching," Appel said. "The environment is pretty tough out there. There are lots of incentives to do the wrong thing."

Success in controlling blood pressure for millions of Americans "will take some environmental changes," Appel said.

"It's everything," he said. "When I go to a scientific meeting, even one sponsored by the heart association, there are three days of meetings with no physical activity. If I go to a party, people will provide sweets that are high in calories and low in nutrition."

The message about lifestyle changes that are needed to control blood pressure is getting out, "but slowly," Appel said. "Ultimately, individuals have to make their own decisions."

More information

A guide to lowering high blood pressure is available from the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Victor J. Stevens, Ph.D, senior investigator, Kaiser Permanente Center for Health Research, Portland, Ore.; David W. Harsha, M.D., associate professor, nutrition and chronic disease, Louisiana State University, Baton Rouge; Lawrence Appel, M.D., professor, medicine, Johns Hopkins Medical Institutions, Baltimore; April 4, 2006, Annals of Internal Medicine

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