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Can Multiple Lifestyle Changes Help Lower Blood Pressure?
A new study suggests that they can – but a Jefferson cardiologist urges caution.
Persons offered intensive counseling made major lifestyle changes that helped them bring their high blood pressure down to
healthy levels, says a report in the Annals of Internal Medicine. Physicians involved in the new study differ on whether lessons learned in the study can be applied on a large scale in real
life, and a Thomas Jefferson University Hospital cardiologist urges caution in interpreting and applying the results.
To be sure, no one questions the need to fight high blood pressure, which is a major risk factor for heart disease and the
leading risk factor for stroke. An estimated 65 million adults have outright high blood pressure, and another 59 million have
levels high enough to raise concern, according to the National Heart, Lung, and Blood Institute (NHLBI).
The study, sponsored by the NHLBI, included 810 men and women with either high blood pressure (readings of more than 140/90),
or levels slightly above the desired 120/80. None of the participants were taking medication for the condition.
Study participants were divided into three groups:
- The first group received two 30-minute sessions of advice on the standard measures for controlling blood pressure.
- The second group attended 18 counseling sessions during the first six months of the study, followed by 15 sessions over the
next 12 months. They were given goals for weight loss, physical activity, and salt and alcohol intake.
- The third group received the same counseling plus added advice on following the DASH (Dietary Approaches to Stop Hypertension)
Eating Plan, a diet rich in fruits, vegetables and low-fat dairy products and low in total fat and cholesterol.
The number of participants with high blood pressure declined in all three groups over 18 months, but the drop was greatest
in the group that got the most advice.
At the start, 37 percent of all participants had high blood pressure. After 18 months, that dropped to 32 percent of those
getting minimum counseling, 24 percent of those receiving intensive counseling, and 22 percent of those getting counseling
plus dietary advice.
Important caveats
The researchers who performed the study view the results as affirmation that individuals with hypertension can and should
make complex lifestyle changes. Matthew DeCaro, MD, a cardiologist at Thomas Jefferson University Hospital, agrees – but adds
some important caveats.
“The study is significant,” Dr. DeCaro says. “It indicates that lifestyle advice can lead to blood-pressure reduction without
medication, and that the more detailed the advice, the better the reduction.”
However, Dr. DeCaro is quick to note that in other studies that didn’t rely on volunteers, the absolute blood pressure reductions
haven’t been nearly as good: “Volunteers tend to be more motivated than non-volunteers and therefore more likely to follow
the advice.”
He also notes that the actual difference in blood-pressure reduction between the three groups is small.
Although the study suggests that it is possible – and beneficial – to make multiple lifestyle changes simultaneously, it may
not be an easy thing for individuals to do on their own. And as Dr. DeCaro explains, obtaining in-depth dietary counseling
can be an expensive proposition for a patient.
“Few or no insurance carriers will pay for the services of dieticians, who are the ones best-qualified to lead this kind of
approach,” he says.
Above all, Dr. DeCaro advises patients with hypertension to keep these results in perspective.
“Making positive changes to your diet and other aspects of your lifestyle is always a good idea,” he says. “Even so, I hope
this study won’t give the impression that most people with high blood pressure will be able to control the condition with
those measures alone. The fact is, most people will need medication to properly manage their hypertension.”
