Comprehensive lifestyle modification and blood pressure control: a review of the PREMIER trial

Abstract

The PREMIER trial assessed the aggregate effect on blood pressure (BP) of nationally recommended lifestyle modifications in free-living adults with high-normal (stage 1) hypertension. Participants (N=810) were randomized to the advice-only group; the established group (consisting of weight loss, increased physical activity, and reduced sodium and alcohol intake); or the established plus Dietary Approaches to Stop Hypertension (DASH) diet group (consisting of the established interventions in addition to the DASH dietary pattern). The primary outcome was change in systolic BP at 6 months. Net of advice only, mean systolic BP declined by 3.7 mm Hg for members of the established group (p<0.001) and 4.3 mm Hg for the established plus DASH group (p<0.001). The prevalence of hypertension decreased from a baseline of 38% to 17% in the established group (p=0.01) and to 12% in the established plus DASH group (p<0.001) compared with a decrease to 26% in the advice-only group. The PREMIER trial demonstrated that persons with above-optimal BP and stage 1 hypertension can make multiple lifestyle changes leading to better control of BP.

Figures

Figure 1

Mean systolic blood pressure (SBP) and diastolic blood pressure (DBF) over time by randomization group. DASH=Dietary Approaches to Stop Hypertension. Reprinted with permission from JAMA. 2003;289:2083–2093.12©2003 American Medical Association. All rights reserved.

Figure 2

Percentage of participants with hypertension at 6 months by randomization group. DASH=Dietary Approaches to Stop Hypertension; *baseline prevalence of hypertension was similar (37%–38%) in each group. Reprinted with permission from JAMA. 2003;289:2083–2093.12©2003 American Medical Association. All rights reserved.

Figure 3

Percentage of participants with optimal blood pressure at 6 months by randomization group. DASH=Dietary Approaches to Stop Hypertension. Reprinted with permission from JAMA. 2003;289:2083–2093.14©2003 American Medical Association. All rights reserved.