March 4, 1992JAMA
The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I
Key result
Weight reduction lowers diastolic BP by ~2 mm Hg, unlike stress management or nutritional supplements.
- MD -2.3
- P<.01
- n=2,182
Why the study?
The short-term feasibility and efficacy of seven nonpharmacologic interventions in persons with high normal diastolic blood pressure were not established.
Do nonpharmacologic interventions (lifestyle changes and nutritional supplements) reduce diastolic blood pressure in adults with high normal levels?
Population
2182 men and women aged 30 through 54 years with diastolic blood pressure 80 through 89 mm Hg
Comparison
Three lifestyle change groups vs unmasked nonintervention controls; four nutritional supplement groups vs placebo controls
Design
Randomized controlled multicenter trials with unmasked and double-blind components
Follow-up
6 to 18 months
Authors
Discussion
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Implication
Recommend weight loss and sodium reduction for high-normal diastolic BP; confirms lifestyle efficacy while challenging stress management and supplements.
Study Design
Type
RCT (n=2,182)
Blinding
Double-blind and unmasked
Randomization
Randomized
Multicenter
Yes
Structured PICO
Do nonpharmacologic interventions (lifestyle changes and nutritional supplements) reduce diastolic blood pressure in adults with high normal levels?
P
Population
2,182 men and women aged 30 to 54 years with high normal diastolic blood pressure (80-89 mm Hg), followed for 6 to 18 months.
I
Intervention
Three life-style change groups (weight reduction, sodium reduction, and stress management) over 18 months, and four nutritional supplement groups (calcium, magnesium, potassium, and fish oil) over 6 months
C
Comparator
Unmasked nonintervention controls for life-style change groups; placebo controls for nutritional supplement groups
O
Outcome
Change in diastolic blood pressure from baseline to final follow-up, measured by blinded observerssurrogate
Main Result
Mean Difference: -2.3
p-value: p=<.01
Weight reduction and sodium reduction are effective nonpharmacologic strategies for lowering blood pressure in individuals with high normal diastolic blood pressure, whereas stress management and nutritional supplements are not.
Limitations
- The long-term effects of weight reduction and sodium reduction, alone and in combination, require further evaluation.
Cite This Study
Whelton et al. (1992) conducted an RCT in High normal diastolic blood pressure (n=2,182). Nonpharmacologic interventions (weight reduction, sodium reduction, stress management, nutritional supplements) vs. Nonintervention controls or placebo was evaluated on Change in diastolic blood pressure from baseline to final follow-up (MD -2.3, p=<.01). Weight reduction and sodium reduction significantly lowered diastolic blood pressure by 2.3 mm Hg (P<.01) and 0.9 mm Hg (P<.05) respectively, while stress management and supplements had no effect.