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Exercise and dietary advice can reduce blood pressure

BMJ 2003; 326 doi: (Published 03 May 2003) Cite this as: BMJ 2003;326:952
  1. David Spurgeon
  1. Quebec

    The prevalence of uncontrolled hypertension among 810 adults who were counselled on weight loss, exercise, and a low salt diet and who were given specific instructions on their diet dropped radically in six months, says a study in the Journal of the American Medical Association (2003;289:2083-93).

    The chairman of the study, Lawrence Appel, professor of medicine, epidemiology, and international health at Johns Hopkins University, said the study “shows that people can simultaneously make multiple lifestyle changes that lower their blood pressure and improve their health.” He said the key issue now is helping people to maintain such changes.

    The study presents the main results of a clinical trial carried out at four centres: Johns Hopkins (Baltimore, Maryland), Pennington Biomedical Research Centre (Baton Rouge, Louisiana), Duke University Medical Centre (Durham, North Carolina), and the Kaiser Permanente Centre for Health Research (Portland, Oregon). The average age of the participants was 50. Nearly two thirds (62%) were women, and 34% were African-American. On average the participants were overweight and sedentary.

    It is the first study to determine the effects of simultaneously implementing two established recommendations for reducing blood pressure: a combination of weight loss, sodium reduction, increased exercise, and limiting alcohol intake, and the “dietary approaches to stop hypertension” (DASH) diet.

    Participants had blood pressure in the ranges 120–159 mm Hg systolic and 80–95 mm Hg diastolic and were not taking antihypertensive drugs. They were randomised into three groups.

    The first group (“advice only”), with 273 people, had one half hour session with a registered dietician, who gave general advice on lowering blood pressure. The second group (“established”), with 268 people, had 18 sessions over six months involving counselling on weight loss, salt reduction, and exercise but were not advised to follow the DASH diet. The third group (“established plus DASH”), with 269 people, had 18 counselling sessions with the same advice as in the second group but were also advised on the DASH diet.

    The DASH diet is high in fruits, vegetables and low fat dairy products and low in fats, red meats, sweets, and beverages containing sugars.

    Blood pressure fell in all three groups, but the third group had the best results.

    The study reported: “After subtracting change in advice only, the mean net reduction in systolic blood pressure was 3.7 mm Hg (P<.001) in the established group and 4.3 mm Hg (P<.001) in the established plus DASH group; the systolic blood pressure difference between the established and established plus DASH groups was 0.6 mm Hg (P=.43).

    “Compared with the baseline hypertension prevalence of 38%, the prevalence at six months was 26% in the advice only group, 17% in the established group (P=.01 compared with the advice only group, and 12% in the established plus DASH group (P<.001 compared with the advice only group; P=.12 compared with the established group).

    “The prevalence of optimal BP (<120 mm Hg systolic and <80 mm Hg diastolic) was 19% in the advice only group, 30% in the established group (P=.005 compared with the advice only group), and 35% in the established plus DASH group (P<.001 compared with the advice only group; P=.24 compared with the established group).”

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