Multiple Lifestyle Changes Help Lower Blood Pressure

Persons offered intensive counseling made major lifestyle changes that helped them bring their high blood pressure down to healthy levels, says a report in the Annals of Internal Medicine.

But physicians involved in the new study differ 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 (NHLBI).

The More Help the Better

The study, sponsored by the NHLBI, included 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.

The participants were divided into three groups. The first group received 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 the DASH (Dietary Approaches to Stop Hypertension) Eating Plan, 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 result was a clear success, says Victor J. Stevens, Ph.D., a senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., and coordinator of data from the study.

"This is very good news," Dr. Stevens says. "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."

Complex Approach Doable

More than that, notes Dr. Stevens, the study shows 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," says Dr. Stevens. "We were worried about combining all of these changes together, but we found that everyday people can deal with these complex things."

"We have to try to come up with a system that could be adopted by healthcare providers," says Dr. David W. Harsha, a nutrition and chronic disease expert at Louisiana State University. The university was one of the centers where the study was conducted.

"We have demonstrated that this is possible, and we will disseminate the information as widely as possible," says Dr. 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," says Dr. Appel.

But it will not be an easy thing for individuals to do on their own, he adds.

"Typically, they will need some coaching," explains Dr. Appel. "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," Dr. Appel says.

"It's everything," he notes. "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," says Dr. Appel said. "Ultimately, individuals have to make their own decisions."

Always consult your physician for more information.