PREMIER: Lifestyle Interventions for Blood Pressure Control

Objectives:

To determine the effect on blood pressure (BP) of 2 multicomponent, behavioral interventions.

Background:

Weight loss, sodium reduction, increased physical activity, and limited alcohol intake are established recommendations that reduce BP. The Dietary Approaches to Stop Hypertension (DASH) diet also lowers BP. To date, no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations.

Subjects:

Randomized trial with enrollment at 4 clinical centers (January 2000-June 2001) among 810 adults (mean [SD] age, 50 [8.9] years; 62% women; 34% African American) with above-optimal BP, including stage 1 hypertension (120-159 mm Hg systolic and 80-95 mm Hg diastolic), and who were not taking antihypertensive medications.

Design and Intervention:

Randomized controlled clinical trial that tested two behavioral interventions compared with an advice-only group over a period of 18 months. The two interventions promoted established recommendations that reduce BP. One intervention in addition promoted the DASH diet, which is rich in fruits, vegetables, and low-fat dairy products, and low in saturated fat, total fat, and cholesterol.

Conclusions:

Individuals with above-optimal BP, including stage 1 hypertension, can make and largely sustain multiple lifestyle changes. These lifestyle changes lower BP, improve BP control, and may reduce cardiovascular disease risk. (JAMA 2003;289:2083-2093; Ann Intern Med 2006;144:485-495).