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Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age

Journal of Human Hypertension volume 19, pages 21–31 (2005)Cite this article

Abstract

Recommendations for control of high blood pressure (BP) emphasize lifestyle modification, including weight loss, reduced sodium intake, increased physical activity, and limited alcohol consumption. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern also lowers BP. The PREMIER randomized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups. Participants with above-optimal BP through stage 1 hypertension were randomized to an Advice Only group or one of two behavioural interventions that implement established recommendations (Est) or established recommendations plus DASH diet (Est plus DASH). The primary outcome was change in systolic BP at 6 months. The study population was 810 individuals with an average age of 50 years, 62% women, 34% African American (AA), 95% overweight/obese, and 38% hypertensive. Participants in all the three groups made lifestyle changes. Mean net reductions in systolic (S) BP in the Est intervention were 1.2 mmHg in AA women, 6.0 in AA men, 4.5 in non-AA women, and 4.2 in non-AA men. The mean effects of the Est Plus DASH intervention were 2.1, 4.6, 4.2, and 5.7 mmHg in the four race–sex subgroups, respectively. BP changes were consistently greater in hypertensives than in nonhypertensives, although interaction tests were nonsignificant. The Est intervention caused statistically significant BP reductions in individuals over and under age 50. The Est Plus DASH intervention lowered BP in both age groups, and significantly more so in older individuals. In conclusion, diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk.

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Acknowledgements

We are extremely grateful to our participants for their sustained commitment to the trial. We also thank Eva Obarzanek, PhD, Jeffrey A Cutler, MD, Michael Proschan, PhD, and Denise Simons-Morton, MD, PhD, at NHLBI for their valuable contributions to the design of PREMIER, and thank the members of the Data, Safety and Monitoring Board that included Jerome D Cohen (chair), Nancy R Cook, ScD, Patricia Dubbert, PhD, Keith C Ferdinand, MD, Jim Raczynski, PhD, and Linda Van Horn, PhD. We thank Christine Pfeiffer PhD, Chief, NHANES and Global Micronutrient Laboratory; Elaine W Gunter MT, Deputy Director, Division of Laboratory Sciences, Centers for Disease Control and Prevention; Thomas G Cole, PhD, Director, Core Laboratory for Clinical Studies, Washington University in St. Louis; Helen S Wright, PhD, Principal Investigator, Pennsylvania State University Diet Assessment Center; Diane C Mitchell, Investigator, Pennsylvania State University Diet Assessment Center; Shiriki Kumanyika, PhD, MPH, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; Jerome Williams, PhD, Howard University; Leslie Pruitt, PhD, Stanford Center for Research in Disease Prevention, Stanford University School of Medicine; and Abby King, PhD.

In addition, we extend our appreciation to individuals at each of the participating sites.

From the Coordinating Center, Center for Health Research, Portland, OR: Mikel Aickin, PhD, Jack Hollis, PhD, Njeri Karanja, PhD, Fran Heinith, BSN, Kristy Funk, MS, RD, Michael Allison, BS, Chuhe Chen, PhD, Clifton Hindmarsh, MS, Terry Kimes, MS, Wan-Ru Li, MBA, Gayle Meltesen, MS, Carrie Meeks, Nadia Redmond, MSPH, Rina Smith, BA, PgDipLGA.

From Duke University Medical Center, Durham, NC: Colleen McBride, PhD, Jamy Ard, MD, Kathleen Aicher, Blondeaner Brown, Denise Ernst, Jeanne Gresko, Madhuri Kesari, Femke Lamers, LaTonya Nealon, Tori Phelps, LaVerne Pruden, LaChanda Reams, Patrice Reams, Benjamin Reese PsyD, Fran Rukenbrod, Sonia Steele, Natalie Thorpe, Olaunda Williams, Chenghua Yang.

From Pennington Biomedical Research Center, Baton Rouge, LA: Philip Brantley, PhD, Allison Worthen, Betty Kennedy, PhD, Emily Griffin, Erma Levy, Terri Keller, Shantell Jones, Katherine Lastor.

From Johns Hopkins Medical Center, Baltimore, MD: Barbara Bailey, MS, RD, Jeanne Charleston, RN, MSN, Sharrone Cypress, Arlene Dalcin, MS, RD, Maura Deeley, Charalett Diggs, RN, Thomas P Erlinger, MD, MPH, Ann Fouts, RN, Angela Hall, Charles Harris, Tara Harrison, Megan Jehn, Shirley Kritt, Estelle Levitas, Phyllis McCarron, MS, RD, Edgar R Miller, III, MD, PhD, Pauline Patrick, LD, Charles Powell, Thomas Shields, LeeLana Thomas, MS, RD, Letitia Thomas, Bobbie Weiss, Deborah Young, PhD.

From the Center for Health Research clinical site, Portland, OR: Adrianne C Feldstein, MD MS, Daniel S Laferriere, RN, MSN, Shirley R Craddick, RD MHA, Dana R Larson, RD, MS, Diane J Cook, RD, MPH, Carol L Young, Susan D Arnold, RN, BSN, Donna L Clark, Stanley B Postlethwaite, Titza Suvalcu-Constantin, Carol M Maul, Donna M Gleason, Cheryl A Johnson Ed. M, Pamela G McNeal, Debra D Burch.

This work is supported by the National Heart, Lung, and Blood Institute, NIH grants UO1 HL60570, UO1 HL60571, UO1 HL60573, UO1 HL60574, UO1 HL62828.

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Authors and Affiliations

  1. Duke Hypertension Center and the Sarah W Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, USA

    L P Svetkey

  2. Welch Prevention Center, Johns Hopkins Medical Center, Baltimore, MD, USA

    T P Erlinger, A Feldstein & L J Appel

  3. Kaiser Permanente Center for Health Research, Portland, OR, USA

    W M Vollmer, P J Elmer & V J Stevens

  4. DECA, NHLBI, NIH, Bethesda, MD, USA

    L S Cooper

  5. Department of Nutrition Sciences, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    J D Ard

  6. Pennington Biomedical Research Center, Baton Rouge, LA, USA

    D Harsha

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  1. L P Svetkey
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  4. A Feldstein
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Correspondence to L P Svetkey.

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Svetkey, L., Erlinger, T., Vollmer, W. et al. Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age. J Hum Hypertens 19, 21–31 (2005). https://doi.org/10.1038/sj.jhh.1001770

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  • DOI: https://doi.org/10.1038/sj.jhh.1001770

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