Diet, Exercise Together Effective in Controlling High Blood Pressure


April 24, 2003
Blog Entry, Health

New research suggests that an overhaul of dietary and fitness habits to help prevent or control high blood pressure is feasible with proper coaching, contrary to the theory that too many changes would be overwhelming and ineffective for most people. The best results in the study were achieved when weight loss, salt restriction and exercise were paired with the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables and low fat dairy products. From Duke University:Diet, Exercise Together Effective in Controlling High Blood Pressure

DURHAM, N.C. — New research suggests that an overhaul of dietary and fitness habits to help prevent or control high blood pressure is feasible with proper coaching, contrary to the theory that too many changes would be overwhelming and ineffective for most people. The best results in the study were achieved when weight loss, salt restriction and exercise were paired with the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables and low fat dairy products.

The results of the study, conducted at Duke University Medical Center, Johns Hopkins, Pennington Biomedical Research Center, and the Center for Health Research, were published in the April 23, 2003, issue of the Journal of the American Medical Association. The study, called PREMIER, is funded by the National Heart, Lung and Blood Institute.

Current national recommendations for lowering blood pressure include weight loss, reduced sodium intake, increased physical activity, limited alcohol consumption and DASH diet. The DASH diet increases fruit, vegetable and low-fat dairy consumption, while limiting fats, red meat, sweets and beverages containing sugar. In a study by some of these researchers and others published in 1997 in the New England Journal of Medicine, the DASH diet lowered blood pressure rates without medication, weight loss or reduction of salt intake.

A subsequent study by the same investigators published in 2001 in the New England Journal of Medicine showed that DASH with reduced sodium intake was even more effective than DASH alone. However, the DASH studies were highly controlled nutrition studies in which all foods were provided and not prepared by the participants.

“No previous study has tested the ability of people to adopt DASH on their own or its effectiveness in the ‘real’ world. And no previous study has tested all the other recommendations for lowering blood pressure, either with or without DASH, as an “all-in-one’ intervention,” said Laura Svetkey, M.D., director of Duke Hypertension Center, director of clinical research at the Stedman Nutrition Center, and principal investigator in the PREMIER trial.

The PREMIER trial enrolled 810 generally healthy people with above-optimal blood pressure, including those with stage one hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-95 mmHg). The participants were randomized into one of three groups

–Advice Only

–“Established” intervention including traditional diet and exercise guidance, and

–“Established Plus DASH,” which implemented the same traditional recommendations plus the DASH diet.

None of the participants took medications for hypertension. Those in the “Advice Only” group each met with a registered dietitian at the beginning of the trial to discuss recommendations for weight control, reduced sodium intake, physical activity and the DASH diet for lowering blood pressure. The dietitian gave participants printed educational materials, but counseling on behavior change strategies was not provided.

Participants in both the “Established” and “Established Plus DASH” intervention groups set goals to lose 15 pounds within six months, increase physical activity, lower sodium intake and limit alcohol to one or two drinks per day. The Established Plus DASH group also set goals to increase fruit, vegetable and low-fat dairy intake and reduce saturated fat and total fat. The Established group was given no instructions on the DASH diet. During the initial six months of the trial, both groups met frequently to reinforce behavior modification.

During the first six months of the trial, all participants in both the Established and Established Plus DASH groups significantly lowered their blood pressures in comparison to the Advice Only group. The Established Plus DASH group had the lowest prevalence of hypertension — cutting group members’ risk of developing hypertension by 53 percent compared to the Advice Only group.

“At six months, we had 19 participants in the Advice Only group who had to begin anti-hypertensive medication to control their blood pressures, compared to only two in the Established Group and five in the Established Plus DASH group,” said Svetkey. “And both behavior modification groups had a significant number of the participants reach their optimum blood pressure.”

All groups had an overall reduction in weight. In the Established Plus DASH group, 34.3 percent lost 15 pounds or more, while in the Established group, 28.6 percent lost 15 pounds or more. The Advice Only group had only 6.2 percent lose 15 pounds or more.

When participants took a treadmill exercise test, the tests showed fitness increased significantly in both the Established and Established Plus DASH groups. The Established Plus DASH group achieved other lifestyle goals: One-third of these participants reached their goal of consuming nine or more servings of fruits and vegetables every day. Only 6 percent of participants in the other two groups reached this marker.

“Because we have seen how the DASH diet can significantly lower blood pressures, we expected to see a greater reduction in blood pressure rates in the Established Plus DASH than in the Established group, but they were about the same overall,” said Svetkey. “While participants on average increased their fruit and vegetable consumption from 4.8 to 7.8 servings per day, many still did not reach the optimum goal of nine to 12 servings per day. But those on the DASH diet also benefited from other potential benefits: prevention of osteoporosis from the high calcium content, prevention of some cancers from the high fruit and vegetable content, and the prevention of cardiovascular disease from the low fat content.”

Although the results for the Advice Only group were not as striking as the other two, this group did better in losing weight and decreasing sodium intake than expected. Svetkey said this could be because motivated people usually sign on to participate in clinical trials, and may produce better results than could be expected in the average population. “You also have to factor in that even the limited amount of advice and counseling this group received was more than most people get in clinical practice, so that contributed as well,” she said.

The long-term goal of the study, said Svetkey, is to follow all the participants an additional 12 months (18 months total) to determine whether the participants can stick with the diet and exercise, and monitor blood pressure control. Also, the next phase in this series of research will focus on weight loss — specifically on how to help people lose weight and keep the weight off long-term. This new study, which is also funded by the National Institutes of Health, will begin enrolling participants in May 2003.




Diet, Exercise Together Effective in Controlling High Blood Pressure

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3 Responses to Diet, Exercise Together Effective in Controlling High Blood Pressure

  1. stanleyluciano July 2, 2009 at 3:13 am #

    As a person who seeks how to become a life coach, I pay very careful attention to both my diet and the diet of my clients – those people that I try to lead to a better future through different motivational training programs. Those that think that achieving success is possible while at the same time eating fast food and all the dangerous food out there are completely mistaken.

    Eat/Breath/Think/Work properly and the goals are going to be achieved sooner or later.

    Best Regards,
    Stanley Luciano

  2. gordman January 10, 2008 at 9:32 am #

    Well this is no news for me as blood pressure problems are quite often these days. I guess we need to comply with the rules and live a stresless healthy life and I don’t see this happening any time soon. I have blood pressure problems and high cholesterol and I usually deal with it by taking generic lipitor.

  3. marlahrd@dashdiet.org August 22, 2006 at 3:36 pm #

    The DASH diet has been proven to support lower blood pressure, lower cholesterol, and to improve insulin sensitivity, in multiple studies.

    However, most people find it hard to put into practice. The DASH Diet Action Plan is a book which has been very well received as being a very user-friendly guide. It provides a wealth of practical tips, 28 days of menu plans (calorie-adjusted), weight loss plans, and advice on how to add exercise, even if you hate to exercise. This is a book for real people, who need to adopt the plan, without a personal dietitian provide individualized advice.

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