Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. The positive effect of an intervention program on the hypertension knowledge and lifestyles of rural residents over the age of 35 years in an area of China Effectiveness of multidisciplinary lifestyle intervention for hypertension: a randomised controlled trial The Effects of Lifestyle Intervention for Hypertension on Low Back Pain: A Randomized Controlled Trial Lifestyle change diminishes a hypertensive response to exercise in type 2 diabetes. Health Disparities in Lifestyle Choices Among Hypertensive Korean Americans, Non-Hispanic Whites, and Blacks Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics. Lifestyle Interventions, Insulin Resistance, and Renal Artery Stiffness in Essential Hypertension Randomized Controlled Trial on Lifestyle Modification in Hypertensive Patients Effect of lifestyle and/or statin treatment on soluble markers of atherosclerosis in hypertensives Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Adding story-centered care to standard lifestyle intervention for people with Stage 1 hypertension. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age Lifestyle interventions influence relative errors in self-reported diet intake of sodium and potassium. Effects of the PREMIER Interventions on Health-Related Quality of Life Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS). Fluvastatin and lifestyle modification for reduction of carotid intima-media thickness and left ventricular mass progression in drug-treated hypertensives. Counselling on Lifestyle Factors in Hypertension Care After Training on the Stages of Change Model Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): an open-label, cluster-randomised trial. Music versus lifestyle on the autonomic nervous system of prehypertensives and hypertensives--a randomized control trial. Untreated hypertension among Australian adults: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Non-pharmacological treatment of hypertension in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland
BACKGROUND Data on the impact of the many dietary and lifestyle factors on the prevalence of  hypertension  in Western societies are lacking . This study quantified the contributions of body weight , physical inactivity and dietary factors to the prevalence of hypertension in Finl and , Italy , the Netherl and s , United Kingdom ( UK ) and USA . METHODS Distributions of blood pressure ( BP ) and risk factors in Western population s were obtained from nationwide surveys . The effect of risk factors on BP was assessed by meta-regression analysis of r and omized trials , published between 1966 and March 2001 . Population attributable risk percentages ( PAR% ) for hypertension ( i.e. systolic BP > or = 140 mmHg ) were computed for all risk factors in the five countries . RESULTS Being overweight made the largest contribution to hypertension , with PAR% between 11 % ( Italy ) and 25 % ( USA ) . PAR% were 5 - 13 % for physical inactivity , 9 - 17 % for high sodium intake , 4 - 17 % for low potassium intake and 4 - 8 % for low magnesium intake . The impact of alcohol was small ( 2 - 3 % ) in all population s. PAR% varied among population s for inadequate intake of calcium ( 2 - 8 % ) , magnesium ( 4 - 8 % ) , coffee ( 0 - 9 % ) and fish fatty acids ( 3 - 16 % ) . CONCLUSIONS Diet and lifestyle have a substantial impact on  hypertension  in Western societies , with being overweight , physical inactivity , high sodium intake and low potassium intake being the main contributors . The relative significance of different risk factors varies among population s , which is important for preventative strategies Hypertension ( HTN ) is a leading cause of cardiovascular and cerebrovascular diseases . Lifestyle modification may be the preferential approach to prevent and control HTN . The purpose of this study was to evaluate the effects of a community intervention program , which focused on improving the HTN knowledge , diets and lifestyles in a rural Chinese area . The study was carried out in a rural area of the Hubei Province from May 2003 to April 2006 . A total of 1632 participants were recruited . Of the participants , 826 from the town of Xiaoxita and 806 from the town of Fenxiang were assigned to the intervention group ( group I ) and to the control group ( group C ) , respectively . Group I participants underwent an intervention that included HTN education and dietary and lifestyle guidance . Group C participants were not subjected to an intervention . The outcome measures included HTN knowledge , dietary and lifestyle behaviors , and prevalence , awareness , treatment and control rates of HTN . Along with the changes in HTN education ( P<0.05 ) , the participants in group I exhibited a significantly greater improvement in dietary habits and lifestyle behaviors , including reducing salty food intake ( 13.6 % ) , fat intake ( 22.9 % ) and alcohol consumption ( 9.6 % ) , after 3 years in comparison with those in group C ( 21.7 , 31.9 and 18 % , respectively ) . The prevalence of HTN was significantly lower in group I ( 22.5 % ) than in group C ( 36 % ) after the intervention strategies . The study showed that the implementation of a community intervention program involving HTN education and lifestyle modifications for rural residents is a powerful approach to reduce HTN prevalence and improve long-term health outcomes Lifestyle factors like weight , alcohol consumption , salt intake and physical activity have shown to be important in treating hypertension . There have been made some r and omised trials about the effects of lifestyle interventions , but the numbers of patients have been relatively small and the duration s of follow-ups have been short . No controlled trials assessing the effects of lifestyle intervention in a rehabilitation setting have been reported . In this study , the effects of multidisciplinary lifestyle intervention in rehabilitation centres among middle-aged hypertensive employees were described . A total of 731 hypertensives from 45 worksites were r and omised to lifestyle intervention in a rehabilitation centre or to usual care in an occupational or primary health-care centre for 12 months . St and ard measurements were conducted before the intervention and 1-year later . Blood pressure ( BP ) levels were clearly reduced in the intervention group , while only minor changes were observed in the control group . The net changes between the two groups both for systolic and diastolic BPs were −2.1 mmHg ( 95 % confidence intervals ( CI ) −4.0 to −0.1 ) and −1.5 mmHg ( 95 % CI −2.6 to −0.4 ) , respectively . The net changes were greater among men than women . The multidisciplinary lifestyle intervention in a rehabilitation centre setting produced significant reductions in BP among middle-aged employees with hypertension Study Design . R and omized controlled trial . Objective . To assess the effects of a lifestyle intervention for hypertension on  low back pain .  Summary of Background Data . According to prospect i ve etiologic studies , a causal association exists between certain lifestyle factors and low back pain . These factors are similar to those that elevate the risk for hypertension . Nevertheless , no r and omized controlled trial has assessed effectiveness of lifestyle intervention for the treatment of hypertension on the prevalence of low back pain . Methods . A total of 731 hypertensive employees from 45 worksites were assigned to multidisciplinary lifestyle interventions for hypertension in a rehabilitation center or to routine care in occupational or primary healthcare services during 12 months . Question naire data on  low back pain were used to assess the effects of the intervention on the extent of low back pain and disability . Results . The changes in prevalence and duration of low back pain , and related disability did not differ between the 2 groups , although there were favorable changes in some risk factors , such as body weight and physical inactivity . Subgroup analyses among patients with moderately heavy or heavy work showed that the prevalence of low back pain during the previous 12 months decreased more in the intervention than in the control group . Conclusion . Multidisciplinary lifestyle intervention aim ed to reduce hypertension is not effective at reducing prevalence of low back pain or disability . However , in thesubgroup of persons doing moderate or heavy work , the intervention seemed to reduce prevalence of low back pain during the 1-year follow-up PURPOSE A hypertensive response to exercise ( HRE ) is common in patients with type 2 diabetes and is associated with increased left ventricular ( LV ) mass and mortality . This study aim ed to determine whether lifestyle modification would improve exercise blood pressure ( BP ) and reduce LV mass in patients with type 2 diabetes . METHODS One hundred and eighty-five patients with type 2 diabetes were r and omized to 1 yr of  lifestyle intervention ( n=97 , mean ± SD age=54.7 ± 11.3 yr , 51 % men ) or  usual care ( control ; n=88 , age=53.8 ± 8.1 yr , 61 % men ) . Brachial BP was measured at rest and during a grade d maximal exercise test at baseline and 1 yr . Patients also underwent two-dimensional echocardiography to determine LV dimensions . A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry . An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women . RESULTS At study entry , there were 101 patients ( 55 % ) with an HRE ( n=51 controls ) . Compared with controls , lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline ( 29.8 % vs 59.5 % , P=0.006 ) . However , absolute values of exercise and resting ( brachial and central ) BP and LV mass were not significantly changed ( all P values > 0.05 ) . There were significant ( all P values < 0.05 ) improvements in V˙O2max , body mass index , plasma glucose , insulin resistance , and HDL cholesterol after lifestyle intervention compared with control . CONCLUSIONS Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes Purpose and Methods . To describe medication profile , diet , and exercise/physical activity  in hypertensive Korean Americans , a convenience sample of 100 hypertensive Korean Americans ( KAs ) at two KA health clinics were interviewed by bilingual Korean nurses using questions from the 1988 - 1994 Third National Health and Nutrition Examination Survey ( NHANES III ) . One hundred age- and gender-matched hypertensive non-Hispanic Whites and 100 Blacks were r and omly selected from the NHANES III data set , and results were compared to describe the health disparities in lifestyle choices among the three groups . Results . The medication profile among the three groups was similar . A majority of members of all three groups had been told by health professionals to exercise for hypertension . KAs made significantly less effort to reduce salt in their diets than did members of the other two groups ( p < .05 ) . Fewer KAs than non-Hispanic Whites or Blacks were following their health professionals’advice to control or lose weight for their high blood cholesterol levels . KAs had the lowest body mass index and were older and more educated than members of the other two groups . KAs ’ primary reasons for using the KA clinic were the respect they received and the use of the Korean language . Implication s. KA health professionals need to teach their patients more about the importance of health-promoting lifestyles for hypertension and its contributing factors . More KA hypertensive patients should follow the advice of health professionals on healthy lifestyles . Nurses should continue to treat patients with respect and provide care with sensitivity to language needs of patients PURPOSE To describe PREMIER , a r and omized trial to determine the effects of multi-component lifestyle interventions on blood pressure ( BP ) . METHODS Participants with above optimal BP through stage 1 hypertension were r and omized to : 1 ) a behavioral lifestyle ( BLS ) intervention that implements established recommendations , 2 ) a BLS intervention that implements established recommendations plus the DASH diet , or 3 ) an advice only st and ard of care group . The two BLS interventions consist of group and individual counseling sessions for 18 months . The primary outcome is systolic BP at 6 months . Additional outcomes include diastolic BP and homocysteine at 6 months ; systolic and diastolic BP at 18 months ; fasting lipids , glucose and insulin at 6 and 18 months ; and effects in subgroup . CONCLUSION Results from the PREMIER trial will provide scientific rationale for implementing multi-component behavioral lifestyle intervention programs to control BP and prevent CVD The study investigates lifestyle and effective anti-hypertensive intervention in overweight-obese patients can influence insulin-resistance ( HOMA-IR ) and US Renal-Resistive-Index ( RRI ) . After a 1-year interventional program ( including a personalized Mediterranean diet , physical activity increase , smoking withdrawal counseling ) , 156 Essential Hypertension ( EH ) patients still have  abnormal HOMA-IR , significantly higher in comparison to 159 control group patients .  Body mass index ( BMI ) and cholesterol-high-density-lipoprotein improvement are the best predictors of a HOMA-IR decrease ; RRI improves in EH according to lifestyle interventions , but no predictor to RRI is identified . Persistence of IR can be tentatively assumed as a steady sign , persistent also after extended lifestyle intervention in EH , further warranting more intensive dietary interventions The authors examined the effects of a comprehensive lifestyle modification intervention on blood pressure ( BP ) and other  cardiovascular risk factors in hypertensive patients . A total of 70 participants were r and omly placed into either a lifestyle intervention or a control group . Four education classes and individual counseling sessions were held for the intervention group . Participants in the control group were provided with routine outpatient services and were asked to maintain their usual lifestyle . Data were gathered at baseline and at the end of 6 months . At the end of 6 months , BP , body weight , body mass index , waist circumference , and fasting lipids , apart from high-density lipoprotein cholesterol , significantly declined in the intervention group . Healthpromoting lifestyle scores of the intervention group had increased significantly compared to those of the control group . In conclusion , the results demonstrate the feasibility of comprehensive lifestyle modification and show its beneficial effects Objectives . To investigate the independent and combined effects of lifestyle changes and statin treatment on soluble markers of atherosclerotic activity . Design . The study was a r and omised , 2 × 2 factorial 1 year intervention trial . Participants ( n=177 ) were sedentary , drug-treated , hypertensive men ( aged 40–74 years ) . They were r and omised to  placebo , lifestyle intervention ( diet and physical activity ) , fluvastatin 40 mg , or the combination of lifestyle and fluvastatin . Results . Lifestyle intervention significantly reduced intercellular adhesion molecule-1 ( sICAM-1 ) compared to usual care ( p=0.003 ) . Thrombomodulin level remained higher among individuals receiving lifestyle intervention ( p=0.025 ) . sICAM-1 was less reduced among fluvastatin treated participants compared to the placebo treated ( p=0.029 ) . Changes of blood pressure , weight or waist circumference were not significantly different between treatment groups . Individuals who achieved improvement of classical risk factors also had a significant reduction of endothelial markers ( E-selectin , von Willebr and s factor , tissue plasminogen activator antigen ) . Conclusions . One year of lifestyle intervention reduced the level of sICAM-1 in sedentary , drug-treated hypertensives , in spite of no impact on traditional risk factors . Low dose fluvastatin had no beneficial effect on the measured markers OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates This study examined the blood pressure (BP)-lowering effect of adding story-centered care ( i.e. , carefully attending to another 's narrative ) to st and ard lifestyle intervention ( i.e. , exercise training and nutrition counseling ) for people with Stage 1 hypertension . The subjects ( N = 24 ) , who were university and hospital employees , were unmedicated and received st and ard lifestyle intervention ; half were r and omly assigned to story-centered care .  Their 24-hour BP was measured four times at 8-week intervals , twice before and twice after the intervention . Subjects who received story-centered care had greater decreases ( p < .05 ) in awake systolic BP over the 6-month study period . Neither systolic nor diastolic sleep BP was significantly affected . Story-centered care showed promise for contributing to the BP-lowering effect of lifestyle intervention . Approaches for integrating story-centered care into the treatment of people with hypertension are challenging but warrant further attention National guidelines for the prevention and treatment of hypertension recommend sodium reduction , weight loss , the Dietary Approach to Stop Hypertension ( DASH ) diet , and regular aerobic exercise . However , no trial has assessed the efficacy of simultaneously implementing all of these recommendations . The objective of this study was to determine the effects on blood pressure and other cardiovascular disease risk factors of a comprehensive lifestyle intervention . We conducted a r and omized controlled trial of 44 hypertensive , overweight adults on a single blood pressure medication . Participants were r and omized to a lifestyle or control group . For 9 weeks , the lifestyle group was fed a hypocaloric version of the DASH diet that provided 100 mmol/d of sodium . This group also participated in a supervised , moderate-intensity exercise program 3 times per week . The control group received no intervention . Outcomes were ambulatory blood pressure , serum lipids , weight , and fitness . At the end of the intervention , mean weight loss in the lifestyle group , net of control , was 4.9 kilograms . In the lifestyle group mean net reductions in 24-hour ambulatory systolic and diastolic blood pressures were 9.5 mm Hg ( P<0.001 ) and 5.3 mm Hg ( P<0.002 ) , respectively . Corresponding changes in daytime systolic and diastolic blood pressures were 12.1 mm Hg ( P<0.001 ) and 6.6 mm Hg ( P<0.001 ) . The lifestyle group experienced mean reductions in total cholesterol ( -25 mg/dL , P<0.001 ) , low-density lipoprotein cholesterol ( -18 mg/dL , P=0.005 ) , high-density lipoprotein cholesterol ( -5 mg/dL , P<0.001 ) , net of control . In conclusion , among hypertensive overweight adults already on antihypertensive medication , a comprehensive lifestyle intervention can substantially lower blood pressure and improve blood pressure control Recommendations for control of high blood pressure ( BP ) emphasize lifestyle modification , including weight loss , reduced sodium intake , increased physical activity , and limited alcohol consumption . The Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern also lowers BP . The PREMIER r and omized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups . Participants with above-optimal BP through stage 1 hypertension were r and omized to an Advice Only group or one of two behavioural interventions that implement established recommendations ( Est ) or established recommendations plus DASH diet ( Est plus DASH ) . The primary outcome was change in systolic BP at 6 months . The study population was 810 individuals with an average age of 50 years , 62 % women , 34 % African American ( AA ) , 95 % overweight/obese , and 38 % hypertensive . Participants in all the three groups made lifestyle changes . Mean net reductions in systolic ( S ) BP in the Est intervention were 1.2 mmHg in AA women , 6.0 in AA men , 4.5 in non-AA women , and 4.2 in non-AA men . The mean effects of the  Est Plus DASH intervention were 2.1 , 4.6 , 4.2 , and 5.7 mmHg in the four race – sex subgroups , respectively . BP changes were consistently greater in hypertensives than in nonhypertensives , although interaction tests were nonsignificant . The Est intervention caused statistically significant BP reductions in individuals over and under age 50 . The Est Plus DASH intervention lowered BP in both age groups , and significantly more so in older individuals . In conclusion , diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk PURPOSE To characterize the distribution of errors in self-reported sodium and potassium dietary intakes relative to more objective urine measures among participants receiving lifestyle interventions . METHODS We analyzed longitudinal data from 900 individuals with hypertension who had been enrolled in a r and omized controlled clinical trial to establish whether  usual care or three lifestyle interventions ( weight loss , sodium reduction , and combined weight loss and sodium reduction ) could effectively substitute for phamacotherapy . Repeated st and ardized 24-hour diet recalls and 24-hour urine collection s were collected over up to three years of follow-up to estimate sodium and potassium intakes . By contrasting self-reported and urine-based sodium and potassium data collected before and during interventions , we examined the relative impact of intervention assignment on estimated intakes , repeatability , and multivariate measurement error . RESULTS Relative to urine-based measures , mean self-reported sodium intakes were biased about 10 % lower among participants assigned to combined weight loss and sodium reduction , but were unaffected by the other interventions . The repeatability of self-report measures increased slightly with time , particularly among participants assigned to sodium interventions . Errors in self-reported sodium and potassium intakes were correlated before the start of the intervention , but became uncorrelated among individuals assigned to sodium restriction interventions . CONCLUSIONS Lifestyle interventions may influence not only diet intake , but also the measurement of diet intake Background Health-related quality of life ( HRQOL ) is an important aspect of well-being that may improve with health behavior interventions . However , health behavior change is difficult with pressure to maintain status quo . Purpose This report examines the effects of two lifestyle interventions and an advice-only condition on HRQOL . Effects of meeting behavioral goals and weight loss also were examined . Methods Participants were 295 men and 467 women ( 34 % African American ) with pre-hypertension or stage 1 hypertension from the PREMIER trial .  HRQOL was assessed by the Short Form-36 . Participants were assigned r and omly to ( 1 ) advice only ( ADVICE ) , ( 2 ) established guidelines for blood pressure control ( EST ) , or ( 3 ) established guidelines plus the Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern ( EST + DASH ) . Results Assignment to EST result ed in improvement in three HRQOL subscales at 6 months and one at 18 months relative to ADVICE . EST + DASH improved in two subscales at 6 and 18 months compared with ADVICE . Across conditions , total fat , saturated fat , fruit , and vegetable intake change , along with ≥4-kg weight loss , result ed in HRQOL improvements at 6 and 18 months . No improvement was found for change in physical activity , and only a few HRQOL subscales were associated with change in sodium and low-fat dairy intake . Conclusions Intensive lifestyle interventions can result in improvements in HRQOL . Change in dietary intake and weight loss is also important BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4.0 % ) at 3 years , and -5.7 lb ( -3.0 % ) at 4 years . At 4 years , 70 % of participants remained below baseline weight and 34 % maintained a weight loss of 10 lb or greater . Mean change in urinary sodium excretion was -12.5 mmol/8 hr ( -23 % ) at 1 year , -10.7 mmol/8 hr ( -20 % ) at 2 years , -8.4 mmol/8 hr ( -16 % ) at 3 years , and -4.6 mmol/8 hr ( -9 % ) at 4 years . Alcohol intake declined by 1.6 drinks/week among drinkers at 4 years . Reported leisure physical activity increased by 86 % at 1 year and remained 50 % above baseline at 4 years . Beneficial changes in blood pressure and serum lipids were associated with these changes . CONCLUSIONS These results support a role for lifestyle interventions as the initial treatment for stage 1 hypertension and demonstrate that such interventions can be successfully implemented in the clinical setting OBJECTIVES The Hypertension High Risk Management trial ( HYRIM ) investigated the effect of fluvastatin treatment and lifestyle intervention on development of carotid intima-media thickness ( IMT ) in drug-treated hypertensive patients . METHODS AND RESULTS HYRIM was a placebo-controlled , 2 x 2 factorial trial in which 568 drug-treated hypertensive men aged 40 - 74 years with total cholesterol 4.5 - 8.0 mmol/L , triglycerides < 4.5 mmol/L , body mass index 25 - 35 kg/m2 , and a sedentary lifestyle were r and omized to receive either fluvastatin , 40 mg daily , or placebo , and either intensive lifestyle intervention ( physical activity and diet ) or usual care ( treatment of hypertension and other disorders by own private physician ) . Carotid IMT was assessed by B-mode ultrasound vasculography and left ventricular ( LV ) mass was calculated from ultrasound recordings of the heart . Fluvastatin alone reduced the primary study endpoint of 4-year development of IMT in the common carotid artery ( CCA ) compared with placebo ( p=0.0297 ) . Carotid bulb IMT progression over 4 years was also significantly ( p=0.0214 ) reduced by fluvastatin compared with placebo . Fluvastatin significantly lowered LDL-C levels ( mean net difference through 4 years , 0.6 mmol/L ; p<0.0001 ) , and reduced the 2-year development of LV mass ( p=0.0144 ) compared with placebo . Lifestyle intervention had no significant effect on LDL-C , carotid IMT or LV mass , and did not increase the effects of fluvastatin . CONCLUSIONS In drug-treated hypertensive patients in a usual care setting , fluvastatin treatment reduces progression of carotid IMT and LV mass Background : In assisting the nurse 's counselling on lifestyle changes in hypertension care a behaviour model can be used . Aim : To analyse the effects of  nurses ' training on the use of the stages of change model when counselling hypertensive patients to perform lifestyle changes . Methods : As part of a r and omised , controlled trial , 19 nurses belonging to the intervention group took part in video-recorded consultation training with simulated patients .  To evaluate the training , the nurses audio-recorded their consultations with two patients before and after the intervention . Analysis focused on the areas of non-pharmacological treatment and the nurses ' attention to the patients ' readiness for change . Results : Patient participation in the consultations increased after the training . The importance of non-pharmacological treatment was mentioned more frequently for all areas of lifestyle behaviour , exercise , smoking , alcohol consumption , food and stress , and the nurses acquired a more distinct structure for their consultations . The mean length of the recorded consultations increased from 18 min to 20.5 min . All the criteria for fulfillment of attention to patient 's readiness to change were met in nine consultations before the training and in seven after it . After the training , attention was paid to support more frequently than before in the action and maintenance stages and a great deal of information was provided INTRODUCTION Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries . We aim ed to investigate the effectiveness of a population -level intervention led by existing community health workers in reducing the burden of hypertension in a low-income population . METHODS We did a community-based , open-label , two-group , cluster-r and omised controlled trial in Nepal . Using computer-generated codes , we r and omly assigned ( 1:1 ) 14 clusters to a lifestyle intervention led by female community health volunteers ( FCHVs ) or usual care ( control group )  . In the intervention group , 43 FCHVs provided  home visits  every 4 months for lifestyle counselling and blood pressure monitoring .  Eligible participants had been involved in a previous population -based survey , were aged 25 - 65 years , did not have plans to migrate outside the study area , and were not severely ill or pregnant . The primary outcome was mean systolic blood pressure at 1 year . We included all participants who remained in the trial at 1 year in the primary analysis . This trial is registered with Clinical Trials.gov , number NCT02428075 . FINDINGS Between April 1 , 2015 , and Dec 31 , 2015 , we recruited 1638 participants ( 939 assigned to intervention ; 699 assigned to control ) . At 1 year , 855 participants remained in the intervention group ( 425 were normotensive , 175 were prehypertensive , and 255 had hypertension ) and 613 remained in the control group ( 305 were normotensive , 128 were prehypertensive , and 180 had hypertension ) . The mean systolic blood pressure at 1 year was significantly lower in the intervention group than in the control group for all cohorts : the difference was -2·28 mm Hg ( 95 % CI -3·77 to -0·79 , p=0·003 ) for participants who were normotensive , -3·08 mm Hg ( -5·58 to -0·59 , p=0·015 ) for participants who were prehypertensive , and -4·90 mm Hg ( -7·78 to -2·00 , p=0·001 ) for participants who were hypertensive . INTERPRETATION A simple , FCHV-led lifestyle intervention coupled with monitoring of blood pressure is effective for reduction of blood pressure in individuals with hypertension and ameliorates age-related increases in blood pressure in adults without hypertension in the general population of Nepal . FUNDING Aarhus University , Jayanti Memorial Trust OBJECTIVES Ragas of Indian music are said to be beneficial in normalizing blood pressure ( BP ) . The objective of this study was to evaluate the effect of passive listening to relaxing raga on the autonomic functions of hypertensives and prehypertensives and provide scientific evidence . METHODS Ethical clearance was obtained from the institutional review board . A prospect i ve , r and omized controlled trial was done on hundred prehypertensives/stage I hypertensives , r and omly divided into two groups ( n=50 in each ) . Group 1 received music intervention along with lifestyle modifications while Group 2 received only lifestyle modifications ( according to Joint national committee VII guidelines ) . Group 1 listened to raga bhimpalas played on flute for 15min daily for at least 5 days/week for 3 months . The main outcome measures were heart rate variability ( HRV ) ( Power lab 15 T , AD Instruments ) , BP and stress levels ( State Trait anxiety inventory score ) . All HRV variables were log transformed for analysis . Statistical analysis was done using SPSS version 18.0 with P<0.05 being considered statistically significant . RESULTS Group 1 exhibited significant reduction in stress levels , diastolic BP and systolic BP decreased in Group 2 after intervention . Insignificant rise in parasympathetic parameters of HRV ( SDNN , RMSSD , HF ms(2 ) , HF nu ) was seen after intervention in both the groups . We found significantly increased parasympathetic and lower sympathetic parameters ( LF ms(2 ) , LF nu , LF/HF ) in Group 1 and 2 males and females of Group 2 . The results suggest that females of Group 1 were least compliant with the given intervention . CONCLUSIONS Passive listening to Indian music along with conventional lifestyle modifications has a role in normalizing BP through autonomic function modification and thus can be used as a complementary therapy along with other lifestyle modifications OBJECTIVE To measure the prevalence of untreated hypertension in Australian adults , and examine the associations with clinical and lifestyle factors . DESIGN AusDiab , a cross-sectional survey conducted between May 1999 and December 2000 , involved participants from 42 r and omly selected census districts throughout Australia . PARTICIPANTS Of 20 347 eligible people aged > or= 25 years who completed a household interview , 11 247 attended a physical examination  ( response rate , 55 % ) . MAIN OUTCOME MEASURES The prevalence of hypertension ( blood pressure > or= 140/90 mmHg or self-reported use of antihypertensive drugs ) and its treatment ; associations of clinical and lifestyle factors with the treatment of hypertension ; and adequacy of treatment for primary and secondary prevention of cardiovascular disease . RESULTS The prevalence of hypertension was 28.6 per 100 ( 95 % CI , 25.0 - 32.3 ) , and the prevalence of untreated hypertension was 15.2 per 100 ( 95 % CI , 13.2 - 17.2 ) . Of those with untreated hypertension , 80.8 % ( 95 % CI , 74.7%-85.0 % ) had had a  blood pressure check within the preceding 12 months . At least one modifiable lifestyle factor was present in 71.7 % ( 95 % CI , 68.5%-74.8 % ) of participants with untreated hypertension . Although lower risk clinical characteristics of younger age and lack of hyperlipidaemia were independently associated with untreated hypertension , 53.5 % warranted treatment based on current cardiovascular disease prevention guidelines and multivariable absolute risk assessment . CONCLUSIONS Considerable scope remains for reducing the burden of cardiovascular disease through lifestyle modification and rational treatment of hypertension Objective To assess whether lifestyle counselling is effective in non-pharmacological treatment of hypertension in primary health care . Design Open r and omized controlled trial . Setting Ten municipal primary health care centres in eastern Finl and . Patients Seven hundred and fifteen subjects aged 25–74 years with systolic blood pressure 140–179 mmHg and /or diastolic blood pressure 90–109 mmHg or antihypertensive drug treatment . Interventions Systematic health counselling given by local public health nurses for 2 years . Main outcome measures Blood pressure , lipids and lifestyle data were collected annually . Results Among participants with no antihypertensive drug treatment , the net reductions after 1 year both in systolic blood pressure [ −2.6 mmHg ; 95 % confidence interval ( CI ) , −4.7 to −0.5 mmHg ] and in diastolic blood pressure ( −2.7 mmHg ; 95 % CI , −4.0 to −1.4 mmHg ) were significant in favour of the intervention group . This difference in blood pressure change was maintained during the second year . In participants with antihypertensive drug treatment , no significant difference in blood pressure reduction was seen between the groups during the study . Conclusions A relatively modest , but systematic counselling in primary health care can , at least among untreated hypertensive subjects , produce reductions in blood pressure levels that are modest for the individual , but very important from the public health point of view
Robust statistically significant effects were found for improved diet , aerobic exercise , alcohol and sodium restriction , and fish oil supplements : mean reductions in systolic blood pressure of 5.0 mmHg [ 95 % confidence interval ( CI ) : 3.1 - 7.0 ] , 4.6 mmHg ( 95 % CI : 2.0 - 7.1 ) , 3.8 mmHg ( 95 % CI : 1.4 - 6.1 ) , 3.6 mmHg ( 95 % CI : 2.5 - 4.6 ) and 2.3 mmHg ( 95 % CI : 0.2 - 4.3 ) , respectively , with corresponding reductions in diastolic blood pressure .
Relaxation significantly reduced blood pressure only when compared with non-intervention controls .
We found no robust evidence of any important effect on blood pressure of potassium , magnesium or calcium supplements .
Available evidence does not support relaxation therapies , calcium , magnesium or potassium supplements to reduce blood pressure
PURPOSE To quantify effectiveness of lifestyle interventions for hypertension .