March 4, 1992

The Effects of Nonpharmacologic Interventions on Blood Pressure of Persons With High Normal LevelsResults of the Trials of Hypertension Prevention, Phase I

Paul K. Whelton, MD; Lawrence Appel, MD; Jeanne Charleston, RN; et al Arlene Taylor Dalcin, RD; Craig Ewart, PhD; Linda Fried, MD; Delores Kaidy; Michael J. Klag, MD; Shiriki Kumanyika, PhD; Lyn Steffen, MPH; W. Gordon Walker, MD; Albert Oberman, MD; Karen Counts, RD; Heidi Hataway, MS; James Raczynski, PhD; Neil Rappaport, PhD; Roland Weinsier, MD; Nemat O. Borhani, MD; Edmund Bernauer, PhD; Patricia Borhani; Carlos de la Cruz; Andrew Ertl; Doug Heustis; Marshall Lee, MD; Wade Lovelace; Ellen O'Connor; Liz Peel; Carolyn Sugars, RD; James O. Taylor, MD; Beth Walker Corkery, MPH; Denis A. Evans, MD; Mary Ellen Keough, MPH; Martha Clare Morris, MPH; Eleanor Pistorino, RN; Frank Sacks, MD; Mary Cameron, MS; Sheila Corrigan, PhD; Nancy King Wright; William B. Applegate, MD; Amy Brewer, RD; Laretha Goodwin, RN; Stephen Miller, MD; Joe Murphy, PhD; Judy Randle; Jay Sullivan, MD; Norman L. Lasser, MD; David M. Batey, PhD; Lee Dolan; Sheila Hamill; Pat Kennedy, RD; Vera I. Lasser, MA; Lewis H. Kuller, MD; Arlene W. Caggiula, PhD; N. Carole Milas, MS; Monica E. Yamamoto, DrPH; Thomas M. Vogt, MD; Merwyn R. Greenlick, PhD; Jack Hollis, PhD; Victor Stevens, PhD; Jerome D. Cohen, MD; Mildred Mattfeldt-Beman, RD; Connie Brinkmann, RN; Katherine Roth, RD; Lana Shepek, RD; Charles H. Hennekens, MD; Julie Buring, ScD; Nancy Cook, ScD; Ellie Danielson, MIA; Kim Eberlein, MPH; David Gordon, MAT; Patricia Hebert, PhD; Jean MacFadyen; Sherry Mayrent, PhD; Bernard Rosner, PhD; Suzanne Satterfield, MD; Heather Tosteson, PhD; Martin Van Denburgh; Jeffrey A. Cutler, MD; Erica Brittain, PhD; Marilyn Farrand, RD; Peter Kaufmann, PhD; Ed Lakatos, PhD; Eva Obarzanek, PhD.; John Belcher; Andrea Dommeyer; Ivan Mills; Peggy Neibling; Margo Woods, ScD; B.J. Kremen Goldman, RD, MS; Elaine Blethen, RD
Author Affiliations

The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; University of Alabama at Birmingham; University of California at Davis; East Boston (Mass) Neighborhood Health Center; University of Mississippi, Jackson; University of Tennessee, Memphis; New Jersey Medical School, Newark; University of Pittsburgh (Pa); Kaiser Permanente Center for Health Research, Portland, Ore; St Louis (Mo) University School of Medicine; Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; National Heart, Lung, and Blood Institute; University of Minnesota, Minneapolis; Tufts University, Boston, Mass; Lipid Laboratory; Channing Laboratory, Brigham and Women's Hospital, Boston, Mass

JAMA. 1992;267(9):1213-1220. doi:10.1001/jama.1992.03480090061028

Objective.  —To test the short-term feasibility and efficacy of seven nonpharmacologic interventions in persons with high normal diastolic blood pressure.

Design.  —Randomized control multicenter trials.

Setting.  —Volunteers recruited from the community, treated and followed up at special clinics.

Participants.  —Of 16821 screenees, 2182 men and women, aged 30 through 54 years, with diastolic blood pressure from 80 through 89 mm Hg were selected. Of these, 50 did not return for follow-up blood pressure measurements.

Interventions.  —Three life-style change groups (weight reduction, sodium reduction, and stress management) were each compared with unmasked nonintervention controls over 18 months. Four nutritional supplement groups (calcium, magnesium, potassium, and fish oil) were each compared singly, in double-blind fashion, with placebo controls over 6 months.

Main Outcome Measures.  —Primary: change in diastolic blood pressure from baseline to final follow-up, measured by blinded observers. Secondary: changes in systolic blood pressure and intervention compliance measures.

Results.  —Weight reduction intervention produced weight loss of 3.9 kg (P<.01), diastolic blood pressure change of -2.3 mm Hg (P<.01), and systolic blood pressure change of -2.9 mm Hg (P<.01). Sodium reduction interventions lowered urinary sodium excretion by 44 mmol/24 h (P<.01), diastolic blood pressure by 0.9 mm Hg (P<.05), and systolic blood pressure by 1.7mm Hg (P<.01). Despite good compliance, neither stress management nor nutritional supplements reduced diastolic blood pressure or systolic blood pressure significantly (P>.05).

Conclusions.  —Weight reduction is the most effective of the strategies tested for reducing blood pressure in normotensive persons. Sodium reduction is also effective. The long-term effects of weight reduction and sodium reduction, alone and in combination, require further evaluation.(JAMA. 1992;267:1213-1220)