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PREMIER was a randomized trial that tested whether counseling to make simultaneous lifestyle changes could prevent or control high blood pressure. High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke.

The study began in 1998 and enrolled 810 adults with above-optimal blood pressure and who were not taking antihypertensive medications. Participants were randomly assigned to one of three intervention groups: Advice-Only, Established, and Established Plus DASH. All three groups received printed materials about blood pressure and lifestyle. In addition, those in the Advice-Only group received a 30-minute individual session with a nutritionist, which did not include counseling on how to make behavior changes. Participants in the Established group were counseled over 6 months to keep track of their diet, including calorie and sodium consumption, and their physical activity. Those in the Established Plus DASH group had the same intervention as the Established group, but also were taught to follow the DASH diet, which is rich in fruits, vegetables, and low fat dairy products.

After 6 months, blood pressure levels declined in all three groups but the reduction was significantly more in the groups receiving behavioral counseling and largest in the Established Plus DASH group. The results of the study indicated that adults with above-optimal blood pressure, including stage 1 hypertension, can make multiple lifestyle changes that lower blood pressure and reduce their risk of heart disease.

PREMIER was conducted at four clinical centers in Baltimore, Baton Rouge, Durham, and Portland. More information on the DASH eating plan is available at:

Selected References:

Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003;289:2083-93.

Study Website:

Premier Study Website

Press Release:

NHLBI Study Finds All-in-one Approach to Lifestyle Changes Effectively Lowers Blood Pressure

Last Updated March 2011

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