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A controlled clinical trial of the effect of gastric bypass surgery and intensive lifestyle intervention on nocturnal hypertension and the circadian blood pressure rhythm in patients with morbid obesity. Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Effect of a Modest Weight Loss in Normalizing Blood Pressure in Obese Subjects on Antihypertensive Drugs Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. 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Training YMCA Wellness Instructors to Deliver an Adapted Version of the Diabetes Prevention Program Lifestyle Intervention Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study Blood pressure 1 year after stroke: the need to optimize secondary prevention. Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. The effect of a patient education booklet and BP 'tracker' on knowledge about hypertension. A randomized controlled trial. Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: preliminary results. Simple advice on lifestyle habits and long-term changes in biomarkers of inflammation and vascular adhesion in healthy middle-aged men The combination of amlodipine and angiotensin receptor blocker or diuretics in high-risk hypertensive patients: rationale, design and baseline characteristics Effects of paternal and maternal lifestyle factors on pregnancy complications and perinatal outcome. A population-based birth-cohort study: the GECKO Drenthe cohort. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. [The lifestyle modification coaching program for secondary stroke prevention]. Improving Hypertension Control and Patient Engagement Using Digital Tools. Knowledge and adherence to antihypertensive therapy in primary care: results of a randomized trial. Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students Effects of intervention on compliance to referral and lifestyle recommendations given at cholesterol screening programs. Changes in cognitive measures associated with a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). Salt restriction and physical activity in treated hypertensives. Impact on blood pressure control of a six-month intervention project. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. Consumption of a Polyphenol-Rich Grape-Wine Extract Lowers Ambulatory Blood Pressure in Mildly Hypertensive Subjects Prevalence and determinants of hypertension in an un-industrialised rural population of North India Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30–60 years: study protocol for a randomized controlled trial Impact of educational mailing on the blood pressure of primary care patients with mild hypertension
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 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 r and omized 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 OBJECTIVE High visceral adipose tissue ( VAT ) and high liver fat ( LF ) are associated with the metabolic syndrome and diabetes . We studied changes in these two fat depots during weight loss and analyzed whether VAT and LF at baseline predict the response to lifestyle intervention . RESEARCH METHODS AND PROCEDURES One hundred twelve subjects ( 48 men and 64 women ; age , 46 + /- 11 years ; BMI , 29.2 + /- 4.4 kg/m(2 ) ) were studied after a follow up-time of 264 + /- 60 ( SD ) days . Insulin sensitivity was estimated from the oral glucose tolerance test . Body fat depots were quantified using magnetic resonance imaging and spectroscopy . RESULTS Cross-sectionally high VAT ( r = -0.22 , p = 0.02 ) and high LF ( r = -0.36 , p < 0.0001 ) were independently associated with low insulin sensitivity . With intervention , BMI ( -3.0 % ) , VAT ( -12.0 % ) , and LF ( -33.0 % ) were reduced ( all p < 0.001 ) . Insulin sensitivity was improved ( + 17 % , p < 0.01 ) . The changes in BMI ( r = -0.41 ) , VAT ( r = -0.28 ) , and LF ( r = -0.39 ) were associated with the increase in insulin sensitivity ( all p < 0.01 ) . High VAT ( r = -0.28 , p = 0.01 ) and high LF ( r = -0.38 , p < 0.01 ) at baseline were associated with a lesser increase in insulin sensitivity . DISCUSSION Baseline values and changes in BMI , VAT , and LF are related to changes in insulin sensitivity during lifestyle intervention . Subjects with high VAT and LF have a lower chance of profiting from lifestyle intervention and may require intensified lifestyle prevention strategies or even pharmacological approaches to improve insulin sensitivity BACKGROUND Cigarette smokers with elevated blood pressure ( BP ) are at substantially higher risk for cardiovascular events compared to normotensive smokers . Although smoking cessation should be a primary treatment goal for these patients , increases in body weight accompanying smoking abstinence may further increase BP . Intervention strategies that facilitate smoking cessation and modify adverse changes in body weight and BP are needed . METHODS We describe an ongoing multi-site , two-phase , five-year r and omized clinical trial . Participants are cigarette smokers with Prehypertension or Stage I Hypertension . In the first phase , participants receive a smoking cessation intervention combining behavioral counseling and nicotine replacement in an open-label fashion . In the second phase , participants who successfully quit smoking are r and omly assigned to one of three lifestyle interventions : 1 ) weight gain prevention , 2 ) blood pressure control , or 3 ) usual lifestyle . Participants are followed for one year to assess changes in blood pressure , body weight , dietary intake , and physical activity . CONCLUSIONS Results from the proposed study will provide important insights into the efficacy of various approaches to lifestyle modification in smokers at increased risk for cardiovascular events PURPOSE A comprehensive worksite health promotion program design ed to reduce risk factors for cardiovascular disease among 4000 city of Birmingham employees was used to develop and implement a tailored antihypertensive educational intervention .  The mean age of the underlying population was 36 years , 89 % were blue-collar or unskilled workers , 50 % were African Americans and 20 % were female . METHODS First , we identified barriers to hypertension control : low literacy , difficulty underst and ing the need for treatment of asymptomatic disease , and wide variability of health beliefs and priorities . We then tailored an educational program , which offered employees health education sessions on a variety of different topics , including heart disease , cancer , sleep disorders and back injury . All program material s focused on lifestyle changes and the need to seek medical care . This program was offered to all hypertensive workers ; 130 chose to enroll , and 81 completed the program . These 81 participants were matched by age , sex , race and baseline BP with nonparticipating hypertensive workers ( controls ) .  Changes in SBP and DBP from before to after the educational program were used to evaluate the program . RESULTS Overall , intervention participants had a decrease of 4.5 mm Hg in mean SBP ( different from zero , [ p = 0.03 ] ) . African American participants showed a significant decrease ( 7.4 mm Hg , [ p = 0.004 ] ) , as did unskilled intervention participants ( SBP changes = 7.7 mm Hg , [ p = 0.004 ] ) . Although not statistically significant , controls showed decreases in BP in the same direction . CONCLUSION An educational intervention tailored to the specific health perceptions and working conditions of a low literacy population is feasible , and may have a significant effect on hypertension control Coronary heart disease continues to be a leading cause of death in adults . Because many risk factors for heart disease make their first appearance in childhood , early intervention is an attractive strategy for this disease . A convenience sample of 58 third grade children participated in a year-long , quasi-experimental study to compare a school-based educational program , HeartPower ! , to the st and ard health education curriculum . Variables examined included knowledge , hypercholesterolemia , obesity , sedentary lifestyle , hypertension , exposure to cigarette smoke , and parental participation . The students who participated in the HeartPower ! Program showed improvement ( p < 0.05 ) in their knowledge of healthy lifestyles . Modest improvements in hypertension and exposure to tobacco smoke were observed . These results indicate that focused instruction on important health issues may be preferable to a broad approach Background : Lifestyle factors such as weight , salt intake , and physical activity have shown to be important in treating hypertension . The object of this study was to describe feasibility and to assess the effectiveness of a multicomponent lifestyle intervention on high blood pressure ( BP ) of Iranian women . Material s and Methods : This r and omized controlled trial was conducted in four health centers by recruiting 161 women aged 35 - 65 years with high BP and r and omizing them to a 4-week lifestyle modification ( n = 80 ) or control group ( n = 81 ) . BP level and other health behavioral factors were assessed before and after the 4-week intervention and also after 6 months . Results : The mean systolic BP changed from 158.8 ( ±8.1 ) mmHg to 153.2 ( ±6.4 ) mmHg during 4-week and to 145.5 ( ±4.6 ) ) mmHg after 6 months in the intervention group ( P < 0.001 ) . There was a significant difference between two groups of study after 4-week mean = 5.6 ( confidence interval [ CI ] = 5.1 - 6.6 ) and 6 months follow mean ( CI = 12.3 - 14.6).(P < 0.001 ) A significant correlation was detected between systolic BP ( SBP ) and diastolic BP ( DBP ) with weight , body mass index , waist circumference , salt intake , and physical activity level ( P < 0.001 ) . Stepwise regression analyses indicated that the weight , dietary salt intake , and physical activity level were significant predictors of SBP and DBP . Conclusion : The results of this study suggest that lifestyle modification program is associated with improvements in BP level in Iranian women OBJECTIVES To compare 5 antihypertensive drugs and placebo for changes in quality of life ( QL ) . To assess the relationship of lifestyle factors and change in lifestyle factors to QL in participants with stage I diastolic hypertension . METHODS The Treatment of Mild Hypertension Study ( TOMHS ) was a r and omized , double-blind , placebo-controlled clinical trial with minimum participant follow-up of 4 years . It was conducted at 4 hypertension screening and treatment academic centers in the United States . The cohort consisted of 902 men and women with hypertension , aged 45 to 69 years , with diastolic blood pressures less than 100 mm Hg . Informed consent was obtained from each participant after the nature of the procedures had been fully explained . Sustained nutritional-hygienic intervention was administered to all participants to reduce weight , to reduce dietary sodium and alcohol intake , and to increase physical activity . Participants were r and omized to take ( 1 ) acebutolol ( n = 132 ) ; ( 2 ) amlodipine maleate ( n = 131 ) ; ( 3 ) chlorthalidone ( n = 126 ) ; ( 4 ) doxazosin mesylate ( n = 134 ) ; ( 5 ) enalapril maleate ( n = 135 ) ; or placebo ( n = 234 ) . Changes in 7 QL indexes were assessed based on a 35-item question naire : ( 1 ) general health ; ( 2 ) energy or fatigue ; ( 3 ) mental health ; ( 4 ) general functioning ; ( 5 ) satisfaction with physical abilities ; ( 6 ) social functioning ; and ( 7 ) social contacts . RESULTS At baseline , higher QL was associated with older age , more physical activity , lower obesity level , male gender , non-African American race , and higher educational level . Improvements in QL were observed in all r and omized groups , including the placebo group during follow-up ; greater improvements were observed in the acebutolol and chlorthalidone groups and were evident throughout follow-up . The amount of weight loss , increase in physical activity , and level of attained blood pressure control during follow-up were related to greater improvements in QL . CONCLUSIONS In patients with stage I hypertension , antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL . The diuretic chlorthali-done and the cardioselective beta-blocker acebutolol appear to improve QL the most . Success with lifestyle changes affecting weight loss and increase in physical activity relate to greater improvements in QL and show that these interventions , in addition to contributing to blood pressure control , have positive effects on the general well-being of the individual BACKGROUND In Mexico , hypertension is a major cause of disability and death in the elderly , but the most effective way to promote behaviour change in old people is unknown . Low re source interventions that are effective in normal healthcare setting s are urgently needed . We report the results of a r and omized trial of nurse-provided health and lifestyle advice during home visits to elderly people with hypertension in Mexico City . METHODS Subjects were 718 people with hypertension aged > or = 60 years , who were residents of Mexico City and were registered with the Family Medicine Clinics of the Mexican Institute of Social Security ( IMSS ) . A r and omized controlled trial was carried out in which the intervention group was offered nurse visits over 6 months with blood pressure checks and negotiated lifestyle changes . The control group continued to receive usual care . RESULTS After 6 months , 36.5 % of the intervention versus 6.8 % of the control group had a blood pressure of < 160/90 mmHg . The difference in the mean change in systolic blood pressure was 3.31 mmHg ( P = 0.03 , 95 % CI : 6.32 , 0.29 ) and the same difference in diastolic blood pressure was 3.67 mmHg ( P = 0.00 , 95 % CI : 5.22 , 2.12 ) . Weight and sodium excretion fell more in the intervention group , but the difference was not significant . CONCLUSIONS Nurse home visits are effective in reducing blood pressure in hypertensive patients aged > or = 60 years Background — Although trials of lifestyle interventions generally focus on cardiovascular disease risk factors rather than hard clinical outcomes , 10-year coronary heart disease ( CHD ) risk can be estimated from the Framingham risk equations . Our objectives were to study the effect of 2 multicomponent lifestyle interventions on estimated CHD risk relative to advice alone and to evaluate whether differences can be observed in the effects of the lifestyle interventions among subgroups defined by baseline variables . Methods and Results — A total of 810 healthy adults with untreated prehypertension or stage I hypertension were r and omized to 1 of 3 intervention groups : An “ advice-only ” group , an “ established ” group that used established lifestyle recommendations for blood pressure control ( sodium reduction , weight loss , and increased physical activity ) , or an “ established-plus-DASH ” group that combined established lifestyle recommendations with the DASH ( Dietary Approaches to Stop Hypertension ) diet . The primary outcome was 10-year CHD risk , estimated from follow-up data collected at 6 months . A secondary outcome was 10-year CHD risk at 18 months . Of the 810 participants , 62 % were women and 34 % were black . Mean age was 50 years , mean systolic/diastolic blood pressure was 135/85 mm Hg , and median baseline Framingham risk was 1.9 % . The relative risk ratio comparing 6-month to baseline Framingham risk was 0.86 ( 95 % confidence interval 0.81 to 0.91 , P<0.001 ) in the established group and 0.88 ( 95 % confidence interval 0.83 to 0.94 , P<0.001 ) in the established-plus-DASH group relative to advice alone . Results were virtually identical in sensitivity analyses , in each major subgroup , and at 18 months . Conclusions — The observed reductions of 12 % to 14 % in estimated CHD risk are substantial and , if achieved , should have important public health benefits OBJECTIVE To investigate the occurrence and association of arterial hypertension with several lifestyle variables . METHODS Transversal population -based study with a r and om sample of students ( 7 to 14 years of age ) of public and private schools . Variables investigated were nutritional status , blood pressure , and lifestyle ( tobacco use , alcohol intake , physical activity and eating habits ) . RESULTS Out of the 3,169 schoolchildren assessed , 5.0 % had arterial hypertension and 6.2 % had normal-high blood pressure . Classification by gender shows boys 6.4 % and girls 6.0 % with normal-high blood pressure , and boys 4.3 % and girls 5.7 % with arterial hypertension . Body mass index ( BMI ) measurements identified 16.0 % excess weight students , 4.9 % of whom were obese . A significant association ( p = 0.01 ) between arterial hypertension and excess weight was observed . Among the students participating in the study , 11.6 % did not attend physical education classes and 37.8 % had sedentary leisure habits . Twenty students ( 0.6 % ) were smokers and 32.7 % had already experimented with alcohol . None of these variables showed statistical significance as to blood pressure values and nutritional status . CONCLUSION In light of the findings in this study which show schoolchildren with a higher than expected frequency of mean blood pressure and BMI values , associated with a lifestyle that tends to favour the development of cardiovascular diseases , we felt led to propose interventional measures focused on the school as an agent of change and capable of conveying information to family units . This possibility encourages us to propose that schools be partners in promoting health 1 . We assessed whether a lifestyle modification programme implemented by nurse counsellors in a general practice setting would improve blood pressure ( BP ) control in treated hypertensive patients OBJECTIVES Determine whether self-efficacy independently predicted weight loss in a behavioral intervention and explore factors that influence the path between self-efficacy and weight change . DESIGN Secondary analysis of the PREMIER trial , a r and omized controlled trial testing effects of lifestyle interventions on blood pressure . SETTING Four academic medical centers . PARTICIPANTS PREMIER recruited adults ( n = 810 ) with pre-hypertension/stage 1 hypertension , not currently receiving medication . This analysis excluded participants in the control arm , result ing in n = 537 . INTERVENTIONS Participants were r and omly assigned to 1 of 3 groups : advice only , established lifestyle recommendations , or established lifestyle recommendations plus Dietary Approaches to Stop Hypertension dietary pattern . MAIN OUTCOME MEASURES Self-efficacy ( dietary self-efficacy [ DSE ] , exercise self-efficacy [ ESE ] ) , dietary intake , fitness . ANALYSIS Pearson correlations , 1-way analysis of variance , mediation analyses . RESULTS Despite an overall decrease in DSE/ESE , change in DSE/ESE significantly predicted weight change at 6 ( β = -.21 , P < .01 ; β = -.19 , P < .01 , respectively ) and 18 months ( β = -.19 , P < .01 ; β = -.35 , P < .01 ) . Change in percent calories from fat partially mediated the DSE/weight change relationship at 6 months . Change in fitness partially mediated the ESE/weight change relationship at 18 months . CONCLUSIONS AND IMPLICATION S Changes in DSE/ESE were not associated with behavior change as hypothesized . Additional research is needed to identify mediators between self-efficacy and adoption of behaviors that influence weight loss The COMmunity Pharamcists ASSist for Blood Pressure ( COMPASS-BP ) study aim ed to assess the effectiveness of lifestyle support programs administered in community pharmacies on hypertension control . This open-label , two-armed parallel group , cluster-r and omized controlled trial included 73 pharmacies ( clusters ) in Japan r and omized to a control or intervention group . Eligible hypertensive patients ( n = 125 ) , aged 20 - 75 years , received the intervention ( n = 64 ) or the control treatment ( n = 61 ) , as dictated by their pharmacy r and omization . Patients in the intervention group received brochures and healthy lifestyle advice from pharmacists using motivational interviewing methods during pharmacy visits over a 12-week period , with their usual pharmacy care . Conversely , the control group just received usual care . The main outcome measure was a change in morning systolic blood pressure ( SBP ) from baseline to week 12 . The intervention group exhibited a decrease in morning SBP that was 6.0 mmHg greater than that of the control group ( 95 % confidence interval [ CI ] : -11.0 to -0.9 , p = 0.021 ) . In a mixed-effect model for repeated measures analysis , the intergroup difference in morning SBP decrease was -4.5 mmHg ( 95 % CI : -8.5 to -0.6 , p = 0.024 ) . Our findings indicate that implementation of a lifestyle advice program in pharmacies is feasible and may lead to reduced blood pressure Background : Studies of hypertension and cognition variously report adverse , null , and protective associations . We evaluated evidence supporting three potential explanations for this variation : an effect of hypertension duration , an effect of age at hypertension initiation , and selection bias due to dependent censoring . Methods : The Normative Aging Study is a prospect i ve cohort study of men in the greater Boston area . Participants completed study visits , including hypertension assessment , every 3–5 years starting in 1961 . Seven hundred fifty-eight of 1,284 men eligible at baseline completed  cognitive assessment  between 1992 and 2005 ; we used the mean age-adjusted cognitive test Z score  from their first assessment to quantify cognition . We estimated how becoming hypertensive and increasing age at onset and duration since hypertension initiation affect cognition . We used inverse probability of censoring weights to reduce and quantify selection bias . Results : A history of hypertension diagnosis predicted lower cognition . Increasing duration since hypertension initiation predicted lower mean cognitive Z score ( −0.02 st and ard units per year increase [ 95 % confidence interval= −0.04 to −0.001 ] ) , independent of age at onset . Comparing participants with and without hypertension , we observed noteworthy differences in mean cognitive score only for those with a long duration since hypertension initiation , regardless of age at onset . Age at onset was not associated with cognition independent of duration . Analyses design ed to quantify selection bias suggested upward bias . Conclusions : Previous findings of null or protective associations between hypertension and cognition likely reflect the study of persons with short duration since hypertension initiation . Selection bias may also contribute to cross- study heterogeneity Hypertension affects a large proportion of urban African-American older adults . While there have been great strides in drug development , many older adults do not have access to such medicines or do not take them . Mindfulness-based stress reduction ( MBSR ) has been shown to decrease blood pressure in some population s. This has not been tested in low-income , urban African-American older adults . Therefore , the primary purpose of this pilot study was to test the feasibility and acceptability of a mindfulness-based program for low income , minority older adults provided in residence . The secondary purpose was to learn if the mindfulness-based program produced differences in blood pressure between the intervention and control groups . Participants were at least 62 years old and residents of a low-income senior residence . All participants were African-American , and one was male . Twenty participants were r and omized to the mindfulness-based intervention or a social support control group of the same duration and dose . Blood pressure was measured with the Omron automatic blood pressure machine at baseline and at the end of the 8-week intervention . A multivariate regression analysis was performed on the difference in scores between baseline and post-intervention blood pressure measurements , controlling for age , education , smoking status , and anti-hypertensive medication use . Effect sizes were calculated to quantify the magnitude of the relationship between participation in the mindfulness-based intervention and the outcome variable , blood pressure . Attendance remained > 80 % in all 8 weeks of both the intervention and the control groups . The average systolic blood pressure decreased for both groups post-intervention . Individuals in the intervention group exhibited a 21.92-mmHg lower systolic blood pressure compared to the social support control group post-intervention and this value was statistically significant ( p = 0.020 ) . The average diastolic blood pressure decreased in the intervention group post-intervention , but increased in the social support group . Individuals in the intervention group exhibited a 16.70-mmHg lower diastolic blood pressure compared to the social support group post-intervention , and this value was statistically significant ( p = 0.003 ) . Older adults are at a time in life when a reflective , stationary intervention , delivered in residence , could be an appealing mechanism to improve blood pressure . Given our preliminary results , larger trials in this hypertensive study population are warranted OBJECTIVE To assess the effects of a comprehensive , integrated community-based lifestyle intervention on diet , physical activity and smoking in two Iranian communities . METHODS Within the framework of the Isfahan Healthy Heart Program , a community trial was conducted in two intervention counties ( Isfahan and Najaf-Abad ) and a control area ( Arak ) .  Lifestyle interventions targeted the urban and rural population s in the intervention counties but were not implemented in Arak . In each community , a r and om sample of adults was selected yearly by multi-stage cluster sampling . Food consumption , physical exercise and smoking behaviours were quantified and scored as 1 ( low-risk ) or 0 ( other ) at baseline ( year 2000 ) and annually for 4 years in the intervention areas and for 3 years in the control area . The scores for all behaviours were then added to derive an overall lifestyle score . FINDINGS After 4 years , changes from baseline in mean dietary score differed significantly between the intervention and control areas ( + 2.1 points versus -1.2 points , respectively ; P < 0.01 ) , as did the change in the percentage of individuals following a healthy diet ( + 14.9 % versus -2.0 % , respectively ; P < 0.001 ) . Daily smoking had decreased by 0.9 % in the intervention areas and by 2.6 % in the control area at the end of the third year , but the difference was not significant . Analysis by gender revealed a significant decreasing trend in smoking among men ( P < 0.05 ) but not among women . Energy expenditure for total daily physical activities showed a decreasing trend in all areas , but the mean drop from baseline was significantly smaller in the intervention areas than in the control area ( -68 metabolic equivalent task ( MET ) minutes per week versus -114 MET minutes per week , respectively ; P < 0.05 ) . Leisure time devoted to physical activities showed an increasing trend in all areas . A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score , even after controlling for age , sex and baseline values . CONCLUSION The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting AIM The aim of this study was to determine the effect of anti-hypertensive patient-oriented education and in-home monitoring for medication adherence and management of hypertension in a primary care setting , by providing education on healthy lifestyle behaviours and medication adherence . BACKGROUND Hypertension is the third most common cause of death worldwide . Prevalence of hypertension in Turkey is approximately 30 % in the general population and 45 - 50 % in population over 50 . DESIGN R and omised controlled study . METHODS This study conducted in Turkey used a study group comprised of 120 subjects ( 40 Group A , 40 Group B , 40 controls ) , all previously diagnosed with hypertension and who started medication therapy at least one year prior to start of study . The study was conducted between February-November 2006 at public primary health care facilities and homes of the study participants . Participants in Group A and B received a total of six monthly education sessions , four times during clinic visits and two home visits . Medication adherence education for Groups A and B and education about healthy lifestyle behaviours for Group B were administered in a structured and individualised format . The control group was routinely monitored in health care facilities . RESULTS Healthy lifestyle behaviours and perception of self-efficacy regarding medication adherence showed improvement after education sessions in Groups A and B. Systolic and diastolic blood pressures of subjects in Group A and B showed a significant decrease compared with those of the control group ; the blood pressure decrease in Group B was greater than in Group A. CONCLUSION Nurses play an important role in uncontrolled hypertension detection and can improve medication adherence and healthy lifestyle behaviours . RELEVANCE TO CLINICAL PRACTICE Patient education medication adherence alone and in combination with healthy lifestyle behaviour teaching is an effective tool for blood pressure reduction in the hypertensive population in primary health care setting PURPOSE The incidence of renal cell carcinoma is increasing worldwide . Cited risk factors include obesity , smoking and hypertension but few others have been confirmed in prospect i ve studies . We used a prospect i ve cohort to vali date established renal cell carcinoma risk factors and evaluate more controversial risk factors for incident renal cell carcinoma . MATERIAL S AND METHODS A total of 77,260 residents of Washington 50 to 76 years old completed a question naire between 2000 and 2002 on demographic , lifestyle and health data . Incident renal cell carcinoma cases were determined by linkage to the regional cancer registry through December 31 , 2009 . Multivariate methods using covariates and cutoffs selected a priori were applied to analyze the association between renal cell carcinoma and previously studied factors related to lifestyle ( body mass index , smoking and alcohol/fruit/vegetable consumption ) and health ( hypertension , diabetes , kidney disease and viral hepatitis ) . RESULTS There were 249 incident cases of renal cell carcinoma . Independent renal cell carcinoma risk factors in the fully adjusted model were body mass index ( 35 or greater vs less than 25 kg/m2 HR 1.71 , 95 % CI 1.06 - 2.79 ) , smoking ( greater than 37.5 pack-years vs never HR 1.58 , 95 % CI 1.09 - 2.29 ) , hypertension ( HR 1.70 , 95 % CI 1.30 - 2.22 ) , kidney disease ( HR 2.58 , 95 % CI 1.21 - 5.50 ) and viral hepatitis ( HR 1.80 , 95 % CI 1.03 - 3.14 ) . Diabetes was associated with renal cell carcinoma ( HR 1.83 , 95 % CI 1.26 - 2.65 ) in a base model adjusting for age and gender but not in the multivariate model . We found no association between alcohol , fruit or vegetable intake and renal cell carcinoma . CONCLUSIONS We identified a significant association of renal cell carcinoma with obesity , smoking , hypertension , renal disease and viral hepatitis . Identifying risk factors offers an opportunity for targeted education and intervention BACKGROUND Nocturnal hypertension , increased night-to-day systolic blood pressure ( BP ) ratio and nondipper status ( night-to-day systolic BP ratio > 0.9 ) are associated with an increased risk of cardiovascular disease . Our aim was to compare the 1-year effect of Roux-en-Y gastric bypass ( RYGB ) versus a program of intensive lifestyle intervention ( ILI ) only on nocturnal hypertension and circadian BP rhythm . METHODS The study participants were part of a 1-year , controlled clinical trial comparing the effect of RYGB or ILI on obesity-related comorbidities . Ninety participants ( 49 in the RYGB group ) successfully completed 24-hour ambulatory BP monitoring  at baseline and follow-up and were eligible subsequently for analysis . RESULTS A total of 71 subjects ( 79 % ) had nocturnal hypertension at baseline . The number of subjects with nocturnal hypertension decreased from 42 to 14 in the RYGB group ( P ≤ .001 ) and from 29 to 27 ( P = .791 ) in the ILI group . Subjects in the RYGB group had a lesser adjusted odds ratio ( OR ) of nocturnal hypertension at follow-up ( OR 0.15 ; 95 % confidence interval , 0.05 - 0.42 ; P ≤ .001 ) ; however , after further adjustment for weight loss , there was no additional beneficial effect of RYGB ( P = .674 ) . No differences between groups regarding improvement in the night-to-day systolic BP ratio were found after adjustment for 24-hour systolic pressure ( P = .107 ) . Both interventions showed a decrease in the proportion of subjects classified as nondippers , namely , 44 % ( P ≤ .001 ) and 28 % ( P = .002 ) in the RYGB and ILI groups , respectively . CONCLUSION Only RYGB was associated with a decrease in the prevalence of nocturnal hypertension . Both interventions showed an improvement in dipper status , although RYGB was more effective Purpose The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance ( GLB ) program on weight , impaired fasting glucose , hypertension , and hyperlipidemia in an urban , medically underserved community . Methods This study was a single-arm prospect i ve intervention study that was design ed to test the effectiveness of a community-based GLB intervention . In sum , 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m2 and metabolic syndrome . Eligible individuals took part in a 12-week GLB intervention ( n = 105 ) that addressed weight loss and physical activity . Subjects were followed for 24 months . Results The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7 % over the long-term follow-up . Of the participants who lost at least 5 % of their body weight following the intervention , 52.6 % maintained the 5 % weight loss at their last follow-up time , weighing about 20 lb less than they did at baseline . Conclusion Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( 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 . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized 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 . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk Objective : To assess the effect of a lifestyle intervention in lowering/normalizing blood pressure ( BP ) levels in hypertensive ( controlled or not ) obese patients . Methods : In this prospect i ve observational study , 490 obese hypertensive patients , 389 controlled ( BP < 140/90 mm Hg ; CH ) and 101 uncontrolled ( BP ≥ 140/90 mm Hg ; UH ) attended a 3-month lifestyle intervention .  Before and after the intervention we assessed weight , waist circumference , fat mass , BP , metabolic and renal variables , and physical activity . A multivariate regression model was used to determine the predictors of BP changes . Results : 18.9 % of CH and 20.0 % of UH were on ≥ 3 antihypertensive drugs . Weight change ( average -4.9 ± 2.7 % ) was independent of the antihypertensive drugs employed . Systolic BP ( SBP ) decreased by 23 mm Hg and diastolic BP ( DBP ) by 9 mm Hg , in patients with UH most of whom ( 89 % ) normalized BP levels ( in 49 % after a weight loss < 5 % ) . Age , gender , whole and central obesity , concomitance of type 2 diabetes , chronic renal disease , physical activity intensification , and pharmacological therapy did not affect BP lowering . In the regression analysis with SBP change as dependent variable , weight reduction ( β = 0.523 , p = 0.005 ) and group ( UH vs. CH , β = -19.40 , p = 0.0005 ) remained associated with SBP reduction . When DBP change was entered as dependent variable , baseline uric acid remained associated with DBP reduction ( β = 0.824 , p < 0.05 ) . Conclusion : Lifestyle interventions are useful for all obese hypertensive patients in most of whom a modest weight loss is sufficient to normalize BP levels avoiding the aggressive use of multiple antihypertensive drugs Objective To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals . Design R and omized controlled trial . Setting Research studies unit . Participants Overweight hypertensive patients , receiving one or two antihypertensive drugs , were recruited by advertising , and allocated r and omly to a usual care group ( controls ; n = 118 ) or a lifestyle modification group ( programme group ; n = 123 ) . Intervention A 4-month programme of weight loss , a low-sodium ‘ Dietary Approaches to Stop Hypertension’-type diet with added fish , physical activity and moderation of alcohol intake . After 4 months , if mean 24-h ambulatory blood pressure ( ABP ) was less than 135/85 mmHg , antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun . Main outcome measures Antihypertensive drug requirements , ABP , weight , waist girth at 4 months and 1-year follow-up . Results Ninety control group and 102 programme group participants completed the study .  Mean 24-h ABP changed after 4 months by −1.0/−0.3 ± 0.5/0.4 mmHg in controls and −4.1/−2.1 ± 0.7/0.5 mmHg with the lifestyle programme ( P < 0.01 ) . At follow-up , changes in the two groups were not significantly different ( 4.1/1.3 ± 1.1/1.0 mmHg in controls ; 2.5/−0.1 ± 1.1/0.8 mmHg in the programme group ; P = 0.73 ) . At 4 months , drug withdrawal differed significantly between the groups ( P = 0.038 ) in men ( control 44 % ; programme 66 % ) but not in women ( 65 and 64 % , respectively ; P = 0.964 ) . At follow-up , sex-related differences were not significant , and 41 % in the control group and 43 % in the programme group maintained drug-withdrawal status . With the programme , net weight loss was 3.3 kg ( P < 0.001 ) at 4 months and 3.0 kg ( P < 0.001 ) at follow-up ; respective net decreases in waist girth were 3.3 cm ( P < 0.001 ) and 3.5 cm ( P < 0.001 ) . Conclusions A 4-month multifactorial lifestyle modification in patients with treated hypertension  reduced blood pressure in the short-term . Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women OBJECTIVE To provide up date d , evidence -based recommendations for the prevention and management of hypertension in adults . OPTIONS AND OUTCOMES For lifestyle and pharmacological interventions , evidence was review ed from r and omized controlled trials and systematic review s of trials . Changes in cardiovascular morbidity and mortality were the primary outcomes of interest . However , for lifestyle interventions , blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field . For treatment of patients with kidney disease , the progression of kidney dysfunction was also accepted as a clinical ly relevant primary outcome . EVIDENCE A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to up date the 2006 Canadian Hypertension Education Program recommendations . In addition , reference lists were scanned and experts were contacted to identify additional published studies . All relevant articles were review ed and appraised independently by both content and method ological experts using prespecified levels of evidence . RECOMMENDATIONS Dietary lifestyle modifications for prevention of hypertension , in addition to a well-balanced diet , include a dietary sodium intake of less than 100 mmol/day . In hypertensive patients , the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day . Other lifestyle modifications for both normotensive and hypertensive patients include : performing 30 min to 60 min of aerobic exercise four to seven days per week ; maintaining a healthy body weight ( body mass index of 18.5 kg/m2 to 24.9 kg/m2 ) and waist circumference ( less than 102 cm in men and less than 88 cm in women ) ; limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women ; following a diet reduced in saturated fat and cholesterol , and one that emphasizes fruits , vegetables and low-fat dairy products , dietary and soluble fibre , whole grains and protein from plant sources ; and considering stress management in selected individuals with hypertension . For the pharmacological management of hypertension , treatment thresholds and targets should take into account each individual 's global atherosclerotic risk , target organ damage and any comorbid conditions : blood pressure should be lowered to lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease . Most patients require more than one agent to achieve these blood pressure targets . In adults without compelling indications for other agents , initial therapy should include thiazide diuretics ; other agents appropriate for first-line therapy for diastolic and /or systolic hypertension include angiotensin-converting enzyme ( ACE ) inhibitors ( except in black patients ) , long-acting calcium channel blockers ( CCBs ) , angiotensin receptor blockers ( ARBs ) or beta-blockers ( in those younger than 60 years of age ) . First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs . Certain comorbid conditions provide compelling indications for first-line use of other agents : in patients with angina , recent myocardial infa rct ion , or heart failure , beta-blockers and ACE inhibitors are recommended as first-line therapy ; in patients with cerebrovascular disease , an ACE inhibitor plus diuretic combination is preferred ; in patients with nondiabetic chronic kidney disease , ACE inhibitors are recommended ; and in patients with diabetes mellitus , ACE inhibitors or ARBs ( or , in patients without albuminuria , thiazides or dihydropyridine CCBs ) are appropriate first-line therapies . All hypertensive patients with dyslipidemia should be treated using the thresholds , targets and agents outlined in the Canadian Cardiovascular Society position statement ( recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease ) . Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy . Once blood pressure is controlled , acetylsalicylic acid therapy should be considered . VALIDATION All recommendations were grade d according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence -Based Recommendations Task Force . All recommendations reported here achieved at least 95 % consensus . These guidelines will continue to be up date d annually Background : To formulate all intervention strategies for hypertension in the community , it is essential to quantify the magnitude of the disease and its risk factors . The patterns of physical activity have not been studied in terms of their being a risk factor or a predictor of hypertension in Saudi Arabia . Material s and Methods : This was a community-based cross-sectional study using the STEP-wise approach of adults and a multistage , stratified , cluster r and om sample . Data were collected using a question naire which included  sociodemographics , blood pressure , patterns , levels and duration of physical activity .  Results : Of a total of 4758 , 1213 ( 25.5 % ) were hypertensives . Hypertension was significantly negatively associated with total levels and duration of physical activity in leisure , transport , and work . Significant predictors of hypertension included lower levels of work involving a moderate physical activity for 10 min , walking/cycling for 10 min continuously , and vigorous activity during leisure time . Conclusions : Hypertension is prevalent among adults ; physical inactivity is a significant risk factor and predictor . Targeting this modifiable risk factor can help in prevention , early diagnosis , and control Purpose To quantify the incidence of overweight and obesity in nursing professionals and assess nurses ' knowledge of obesity and associated health risks . Data sources A mailed survey to 4980 r and omly selected registered nurses from one state in each of six geographic regions . Response rate was 15.5 % ( n= 760 ) . Descriptive statistics were calculated for continuous variables ; categorical variables were summarized with frequency counts . Results The gr and mean body mass index ( BMI ) of nurses surveyed was 27.2 . Almost 54 % were overweight or obese . Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes . Forty percent are unable to lose weight despite healthy diet and exercise habits . Only 26 % of respondents use BMI to make clinical judgments of overweight and obesity . Although 93 % of nurses acknowledge that overweight and obesity are diagnoses requiring intervention , 76 % do not pursue the topic with overweight and obese patients . Discussion Many nurses provide weight-related health information to the public . These data suggest that they may benefit from continuing education on obesity and its risks . Because 76 % of nurses do not pursue the topic of obesity with patients , they may benefit from education on pursuing sensitive topics during a professional encounter . Nurse practitioners may play a key role in the education of both patients and registered nurses Objective The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking . Methods We conducted a multisite r and omized controlled trial that enrolled smokers unselected for their readiness to quit . There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and r and omly allocated to the intervention or control group . Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20–30 minute follow-up sessions . Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia . Results The point prevalence abstinence rate at 6 months , vali date d by carbon monoxide testing , in the intervention group ( 13.6 % ) was 5.4 times higher ( p<0.001 ) than that in the control group ( 2.5 % ) . When the data were analyzed based on the baseline stage of change , there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives . The odds ratio was 6.4 ( p<0.001 ) in precontemplators , 6.7 ( p<0.001 ) in contemplators , and 6.2 ( p<0.01 ) in preparators . There was a positive , consistent effect of the intervention regardless of study site ( worksite or community ) or the presence of hypertension or hypercholesterolemia . Conclusions We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit . This result suggests that stage-matched individual counseling , based on the transtheoretical model , is effective in smokers with a lower motivation to quit as well as those ready to quit Abstract Aims . The purpose of the present study was to compare the costs of  home blood pressure ( BP ) telemonitoring ( HBPM )  with the costs of conventional office BP monitoring . In a r and omized controlled trial , 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring  during 6 months . Costs were quantified from the healthcare perspective . Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made . Major findings . Systolic and diastolic daytime and night-time ambulatory BP ( ABP ) were reduced in both groups . The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP . For systolic ABP , the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [ 95 % uncertainty interval , UI −860 to 4544 ] . For diastolic ABP , the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [ 95 % UI −674 to 69315 ] . Medication and consultation costs were lowest in the intervention group , but were offset by the cost of the telemonitoring equipment . Conclusions . Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP . The cost-effectiveness result is surrounded with considerable uncertainty . Trial registration : Clinical Trials.gov identifier : NCT282334 CONTEXT Hypertension is an important preventable risk factor for death among women . While several modifiable risk factors have been identified , their combined risk and distribution in the population have not been assessed . OBJECTIVE To estimate the hypothetical fraction of hypertension incidence associated with dietary and lifestyle factors in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 83,882 adult women aged 27 to 44 years in the second Nurses ' Health Study who did not have hypertension , cardiovascular disease , diabetes , or cancer in 1991 , and who had normal reported blood pressure ( defined as systolic blood pressure of < or = 120 mm Hg and diastolic blood pressure of < or = 80 mm Hg ) , with follow-up for incident hypertension for 14 years through 2005 . Six modifiable lifestyle and dietary factors for hypertension were identified . The 6 low-risk factors for hypertension were a body mass index ( BMI ) of less than 25 , a daily mean of 30 minutes of vigorous exercise , a high score on the Dietary Approaches to Stop Hypertension ( DASH ) diet based on responses to a food frequency question naire , modest alcohol intake up to 10 g/d , use of nonnarcotic analgesics less than once per week , and intake of 400 microg/d or more of supplemental folic acid . The association between combinations of 3 ( normal BMI , daily vigorous exercise , and DASH-style diet ) , 4 ( 3 low-risk factors plus modest alcohol intake ) , 5 ( 4 low-risk factors plus avoidance of nonnarcotic analgesics ) , and 6 ( folic acid supplementation > or = 400 microg/d ) low-risk factors and the risk of developing hypertension was analyzed . MAIN OUTCOME MEASURES Adjusted hazard ratios for incident self-reported hypertension and population attributable risks ( PARs ) . RESULTS A total of 12,319 incident cases of hypertension  were reported . All 6 modifiable risk factors were independently associated with the risk of developing hypertension during follow-up after also adjusting for age , race , family history of hypertension , smoking status , and use of oral contraceptives . For women who had all 6 low-risk factors ( 0.3 % of the population ) , the hazard ratio for incident hypertension was 0.22 ( 95 % confidence interval [ CI ] , 0.10 - 0.51 ) ; the hypothetical PAR was 78 % ( 95 % CI , 49%-90 % ) for women who lacked these low-risk factors . The corresponding hypothetical absolute incidence rate difference ( ARD ) was 8.37 cases per 1000 person-years . The PARs were 72 % ( 95 % CI , 57%-82 % ; ARD , 7.76 cases per 1000 person-years ) for 5 low-risk factors ( 0.8 % of the population ) , 58 % ( 95 % CI , 46%-67 % ; ARD , 6.28 cases per 1000 person-years ) for 4 low-risk factors ( 1.6 % of the population ) , and 53 % ( 95 % CI , 45%-60 % ; ARD , 6.02 cases per 1000 person-years ) for 3 low-risk factors ( 3.1 % of the population ) . Body mass index alone was the most powerful predictor of hypertension , with a BMI of 25 or greater having an adjusted PAR of 40 % ( 95 % CI , 38%-41 % ) compared with a BMI of less than 25 . CONCLUSIONS Adherence to low-risk dietary and lifestyle factors was associated with a significantly lower incidence of self-reported hypertension . Adopting low-risk dietary and lifestyle factors has the potential to prevent a large proportion of new-onset hypertension occurring among young women BACKGROUND Bai Ku Yao is an isolated subgroup of the Yao minority in China . Little is known about the association of diet and lifestyle with the prevalence of hypertension in this population . METHODS A total of 485 subjects of Bai Ku Yao and 501 participants of Han Chinese aged 40 - 89 were surveyed using stratified r and omized cluster sampling . Information on diet and lifestyle was collected by using st and ard question naires . Blood pressure ( BP ) and serum lipid levels were measured . RESULTS Physical activity levels , carbohydrate , vegetal protein , and dietary fiber intake were higher in Bai Ku Yao than in Han , whereas educational level , height , weight , body mass index ( BMI ) , waist circumference , and total energy , fat , protein , dietary cholesterol , and salt intake were higher in Han than in Bai Ku Yao . Systolic , diastolic , and pulse pressure ( PP ) levels and the prevalence of hypertension ( 21.9 % vs. 28.9 % , P < 0.05)were lower in Bai Ku Yao than in Han . Hypertension was positively correlated with age , physical activity , BMI , and waist circumference , as well as with total energy , fat , and salt intake , and negatively associated with educational levels and dietary fiber intake in both ethnic groups ( P < 0.05 for all ) . Hypertension was also positively correlated with triglycerides ( TGs ) in Bai Ku Yao and alcohol consumption in Han ( P < 0.05 for each ) . CONCLUSIONS The differences in BP levels and the prevalence of hypertension among the middle-aged and elderly between Bai Ku Yao and Han might result from different dietary patterns , lifestyle choices , physical activity levels , sodium intake , and even genetic factors To determine the association of socio-economic status ( SES ) and prevalence of hypertension  and its risk factors in a rural population , a cross sectional survey was conducted in two r and omly selected villages in the Moradabad district in North India . There were 1935 residents aged over 25 ( 984 men and 951 women ) who were r and omly selected and categorised into social classes 1–4 depending upon SES based on occupation , housing conditions , l and holding , total per capita income , ownership of consumer durables and education . The prevalence of hypertension diagnosed by JNC V criteria ( > 140/90 mm Hg ) was significantly higher among social class 1 and 2 and showed positive relation with SES in both sexes . Among social class 1 and 2 subjects , there was a higher prevalence of overweight and obesity and sedentary lifestyle . Logistic regression analysis with adjustment of age showed that SES had a positive relation with hypertension ( odds ratio : men 1.09 , 95 % CI 1.05–1.14 ; women 1.08 , 95 % CI 1.05–1.13 ) , body mass index ( odds ratio : men 1.12 , 1.08–1.18 ; women 1.11 , 1.06–1.16 ) and sedentary lifestyle ( odds ratio : men 1.45 , 1.32–1.58 ; women 1.38 , 1.26–1.49 ) . Only weak but significant associations were observed with smoking , alcohol and salt intake . The association of hypertension with social class was reduced after adjustment of body mass index , sedentary lifestyle , smoking and salt intake ( odds ratio : men 0.96 , 0.81–1.14 ; women 0.73 , 0.54–1.04 ) . There was an increase in the prevalence of hypertension and age-specific blood pressure ( BP ) with increasing age in both sexes . The overall prevalence of hypertension by WHO criteria ( > 160/95 ) was 4.6 % and by JNC V criteria 20.8 % , and the rates were comparable in both sexes . Social class 1 and 2 subjects in rural North India have a higher prevalence of hypertension and its risk factors of overweight and sedentary lifestyle Hypertension is a major public health issue affecting 68 million adults in the United States . Lifestyle modifications including complementary therapies such as the movement based mind body practice of yoga have become increasingly popular in the United States and have been considered as a potential alternative to medication in blood pressure reduction . We completed a pilot study in 2009 which showed meaningful decreases in 24-hour ambulatory blood pressure readings after a 12 week period of yoga participation . Based on data from our pilot study we are now completing The Lifestyle Modification and Blood Pressure Study ( LIMBS II ) which is a phase 2 r and omized controlled trial design ed to determine the effects of yoga therapy and enhanced lifestyle modification on lowering blood pressure in pre-hypertensive and stage 1 hypertensive subjects . Using 24-hour ambulatory blood pressure monitoring , LIMBS II aims to compare the effects on blood pressure reduction in subjects r and omized for 24 weeks to one of the three following groups : yoga therapy versus blood pressure education program ( sodium restriction and walking program ) versus a combination program that involves components of both groups . LIMBS II will also examine the impact that changes in blood pressure have on cerebral blood flow . If successful , the LIMBS study will determine if yoga therapy combined with enhanced lifestyle modification will result in clinical ly meaningful decreases in blood pressure and thus can be implemented as an alternative to drug therapy for patients with prehypertension and stage 1 hypertension BACKGROUND The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980 - 1981 to another in 1988 - 1989 influence self-reported health status . Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time . METHOD The cross-sectional and the longitudinal analyses are based on the same simple r and om sample of 3,843 adults , aged 25 - 74 , interviewed in 1980 - 1981 and 1988 - 1989 and is part of the Swedish Annual Level-of-Living Survey . About 85 % of the respondents in the first interview participated in a second interview in 1988 - 1989 . Cross-sectional odds ratios , based on a marginal model , were estimated using the generalized estimating equations . The transitional models were analysed using unconditional logistic regression . A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality . RESULTS Physical inactivity , being a current or former smoker and obesity ( women only ) were strong risk factors for poor health either as main effects and /or combined ( interactions ) . There was a strong interaction between physical activity and smoking , and for women , also between body mass index ( BMI ) and physical activity . Smoking , physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking , physically active , and normal-weight women . The corresponding risk for men was about five times higher . Physically active , but smoking and obese individuals showed only moderately increased risks for poor health status . The transitional model showed that those who were physically inactive in 1980 - 1981 , but did exercise in 1988 - 1989 , improved their health after adjustments for sociodemographic and other lifestyle factors . Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality ( 1.6 , 1.9 and 1.8 , respectively ) than those who reported that they were in good status at both points in time . CONCLUSIONS We found that physical activity protects against poor health irrespective of an increased BMI and smoking . The major clinical implication s are the long-st and ing benefits of physical activity and not smoking OBJECTIVE Weight loss through lifestyle changes is recommended for nonalcoholic fatty liver disease ( NAFLD ) . However , its efficacy in patients with type 2 diabetes is unproven . RESEARCH DESIGN AND METHODS Look AHEAD ( Action for Health in Diabetes ) is a 16-center clinical trial with 5,145 overweight or obese adults with type 2 diabetes , who were r and omly assigned to an intensive lifestyle intervention ( ILI )  to induce a minimum weight loss of 7 % or a control group who received diabetes support and education ( DSE ) . In the Fatty Liver Ancillary Study , 96 participants completed proton magnetic resonance spectroscopy to quantify hepatic steatosis and tests to exclude other causes of liver disease at baseline and 12 months . We defined steatosis > 5.5 % as NAFLD . RESULTS Participants were 49 % women and 68 % white . The mean age was 61 years , mean BMI was 35 kg/m2 , mean steatosis was 8.0 % , and mean aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) were 20.5 and 24.2 units/l , respectively . After 12 months , participants assigned to ILI ( n = 46 ) lost more weight ( −8.5 vs. −0.05 % ; P < 0.01 ) than those assigned to DSE and had a greater decline in steatosis ( −50.8 vs. −22.8 % ; P = 0.04 ) and in A1C ( −0.7 vs. −0.2 % ; P = 0.04 ) . There were no significant 12-month changes in AST or ALT levels . At 12 months , 26 % of DSE participants and 3 % ( 1 of 31 ) of ILI participants without NAFLD at baseline developed NAFLD ( P < 0.05 ) . CONCLUSIONS A 12-month intensive lifestyle intervention in patients with type 2 diabetes  reduces steatosis and incident NAFLD Abstract Objective : To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension . Design : Review of medical records in general practice s to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions . Setting : Six general practice s in north west London picked at r and om within defined criteria of geography and size . Subjects : 740 hypertensive patients managed by 25 different general practitioners . Main outcome measures : Improved level of care in terms of better diagnosis by having at least three blood pressure readings before the start of drug treatment , better level of recordings of lifestyle parameters as shown by the level of recordings of body mass index and total lipid values , and better control of blood pressure and harm minimisation as shown by the level of recordings of urea and electrolyte values . Results : Improvement was noted in the level of recordings of body mass index , total lipid concentrations , and urea and electrolyte values but not in better diagnosis or blood pressure control . Conclusion : Clinical behaviour of general practitioners can be changed by peer review but more complex behavioural changes which require the cooperation of the patients and cognitive actions by the general practitioners need further investigation . Key messages Peer review can significantly change the clinical behaviour of general practitioners with respect to undertaking simple diagnostic procedures , recording lifestyle variables , and carrying out laboratory measurements Attempts to improve control of blood pressure by general practitioners is a target less easily achieved A primary care study has shown that despite an active education programme over two years the proportion of treated patients whose blood pressure was controlled to < 160/90 mm Hg remained at only one BACKGROUND Lifestyle modifications may affect the development of diabetes and prevent complications . However , there is no direct evidence to show that lifestyle intervention is beneficial for patients with established type 2 diabetes . OBJECTIVE The ultimate goal is to determine whether long-term lifestyle intervention can improve glycemic control and prevent complications in patients with type 2 diabetes . This initial report on a multi-year study describes protocol s and the analysis of baseline data and three-year interim results . DESIGN The study was a r and omized , controlled , multi-centre , prospect i ve intervention trial . The trial included patients from 59 Japanese institutes specializing in diabetes care . PATIENTS The study enrolled 2 205 patients with previously diagnosed type 2 diabetes . INTERVENTION The lifestyle modification program included intensive lifestyle management at each outpatient clinic visit and frequent telephone counseling . The intervention group received educational material s concerning the importance of lifestyle and behavioural changes , a diary to record progress of laboratory and other data , and a pedometer . MEASUREMENTS Parameters and indices related to glycemic control , diabetic complications , dyslipidemia , hypertension , obesity , and atherosclerosis were measured several times a year . RESULTS Small but significant differences in HbA1c levels between the intervention ( INT ) and conventional ( CON ) therapy groups appeared as early as two years after the start of intervention and were maintained in the third year ( CON group , 7.78 + /- 1.27 % vs. INT group , 7.62 + /- 1.20 % , the initial HbA1c level was 7.80 + /- 1.42 % for the CON group and 7.68 + /- 1.28 % for the INT group ) . Data on differences in occurrence of micro- or macrovascular complications are not yet available . CONCLUSIONS The effect of lifestyle modification on improving the glycemic control of patients with established type 2 diabetes mellitus was small but significant three years after initiation of the intervention Liaoning Province is located in northeast China , which has distinct weather conditions , geographic characteristics and lifestyles compared with other regions of the country ; the lifestyle differences are especially pronounced in the rural parts of this region , where there is a dearth of financial and other re sources . However , information on the prevalence , awareness , treatment , and control of hypertension in these impoverished areas is very scarce . We therefore performed multistage cluster r and om sampling of a group of 29,970 adult residents ( ≥5 years of residency ; ≥35 years of age ) of the rural portions of Liaoning Province from 2005 to 2006 . The sampling included a survey on blood pressure and associated risk factors . The overall prevalence of hypertension in the community was 36.2 % , and 73.0 % of hypertensives were unaware of their condition . Among the total group of hypertensives , only 19.8 % were taking prescribed medication to lower their BP , and 0.9 % had controlled hypertension . Of all subjects , 46.4 % did not think that high blood pressure would endanger their lives . As to the reasons given by hypertensives who were aware of their hypertension for not taking antihypertensive medication , 47.4 % reported that they lacked knowledge about the mortality of hypertension . The average salt intake in hypertensives was 16.6±9.9 g/day , and the percentages of smoking ( 44.3 % ) , drinking ( 31.7 % ) and salt intake > 6 g/day ( 86.8 % ) in hypertensives were high . Logistic regression analysis indicated that the relative risks ( 95 % confidence interval [ CI ] ) of overweight , obesity , smoking , drinking , increased salt intake and family history of hypertension for hypertension were 1.95 ( range , 1.82–2.08 ) , 2.92 ( 2.40–3.55 ) , 1.19 ( 1.12–1.27 ) , 1.16 ( 1.08–1.25 ) , 1.26 ( 1.20–1.33 ) and 2.85 ( 2.66–3.05 ) , respectively . A higher education level was found to be a protective factor . In conclusion , the prevalence of hypertension in adults living in the rural parts of Liaoning Province was high , and the rates of awareness , treatment , and control were unacceptably low , which may have been due to unique geographical characteristics , unwholesome lifestyles , greater sodium intake , lower education levels , and genetic risk factors Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery The authors investigated the efficacy of a lifestyle educational program , organized in small group meetings , in improving the outcome of a nonpharmacologic intervention .  One hundred and eighty-eight hypertensive patients with stable blood pressure ( BP ) levels and drug therapy in the previous 6 months were r and omly divided into educational care ( EC ) and usual care ( UC ) groups . They were followed at 3-month intervals up to 2 years . In addition to the visits in an outpatient clinic , patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment . At baseline , EC and UC groups were similar for age , sex , body mass index ( BMI ) , blood pressure ( BP ) levels , and pharmacologic treatment . Patients in the EC group had significantly reduced total energy , total and saturated fats , and sodium intake . Physical activity was significantly increased in the EC group as well . At the end of the 1-year follow-up , BMI ( P<.001 ) , visceral fat ( P<.001 ) , and BP ( P<.001 ) were significantly lower in the EC group compared with the UC group . Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study BACKGROUND The aim of the trial was to evaluate the effectiveness of a program of cooperation between physician and pharmacist to reduce cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure ( BP ) control , appropriate changes in antihypertensive medications , and beneficial changes in lifestyle . METHODS The 132 subjects in this r and omized , controlled trial were in the age range of 40 - 79 years . The inclusion criteria were : systolic BP ( SBP ) ranging from 140 - 179 mm Hg and /or diastolic BP ( DBP ) ranging from 90 - 99 mm Hg and treatment-naive ( untreated for hypertension ) ; or on a regimen of medication for hypertension . Of these 132 subjects , 124 ( 94 % ) were already receiving treatment with antihypertensive medications . Equal numbers of subjects were r and omly assigned to one of two groups : a physician-pharmacist intervention group ( n = 66 ) and a control group ( n = 66 ) . RESULTS The 6-month follow-up rate was 97 % in both groups . At 6 months , the mean decrease in SBP/DBP , as measured at home in the morning , was 2.9/3.3 mm Hg in the intervention group relative to baseline ( P = 0.02 and P < 0.0001 for SBP and DBP , respectively ) . The mean decrease in home morning SBP in the intervention group was not significantly greater than in the control group . However , the DBP decline was significantly greater in the intervention than control groups , which showed a mean decrease of 2.8 mm Hg ( confidence interval : -5.5 to -0.1 ; P = 0.04 ) . The percentage of patients in whom control of home morning BP was achieved was 53 % in the intervention group and 47 % in the control group ( P = 0.40 ) . A higher percentage of patients in the intervention group , relative to the control group , were able to reduce the use of antihypertensive medications ( 31 vs. 8 % , P < 0.0001 ) , and fewer patients in this group required additional medications or increases in dosage relative to the controls ( 11 vs. 28 % , P = 0.03 ) . Patients of the intervention group were more likely to show reduction in body mass index and sodium intake and to stop smoking , as compared with the control group . CONCLUSIONS A program of cooperation between physician and pharmacist was successful in reducing cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure ( BP ) control , appropriate changes in antihypertensive medications , and beneficial changes in lifestyle It is an important but still unresolved question whether reduction of salt intake in the offspring of hypertensives ( a high risk group ) prevents the development of the disease . Therefore , 178 offspring ( 14 - 26 years old ) of hypertensives were enrolled in a 2-year pilot trial aim ed mainly at a reduction in salt consumption . For the intervention group ( n = 99 ) a behavioural approach was chosen with extensive counselling by experienced dietitians . The controls ( n = 79 ) received no continuous dietary advice . Both groups showed a small decline in sodium intake over time , but the differences between the two groups were not significant . Division into subgroups with and without sodium reduction revealed no differences in blood pressure . We conclude that the inherent resistance to any change of lifestyle among healthy subjects may require new and more comprehensive motivational approaches OBJECTIVE The purpose of this manuscript is to precisely quantify the representation of women , blacks , and very old ( aged 80 or more ) participants in 28 past or ongoing r and omized clinical trials on hypertension , cardiovascular disease , renal disease , and diabetes mellitus . METHODS Selection of the 28 studies was arbitrary , based primarily on the reference being often quoted or cited as relevant data for women , blacks , the elderly , or persons with diabetes mellitus . RESULTS Twenty-three of the 28 studies enrolled a majority of men . Many of the completed trials had an under-representation of blacks ( 0 % to 8 % ) . An adequate number ( 1,091 ) of very old ( aged 80 or more ) persons have been studied for isolated systolic hypertension , but the number of such patients thus far studied for diastolic hypertension is too small to allow evidence -based recommendations for therapy . Reported studies in diabetes have included a majority of men ( average , 58 % ) and four of the five trials review ed enrolled relatively few blacks ( average , 4.6 % ) . CONCLUSIONS Women , blacks , and the very old ( aged 80 or more ) have been under-represented in many past r and omized clinical trials , but ongoing studies will resolve this discrepancy in most instances . The Women 's Health Initiative ( WHI ) will provide data on 161,861 multi-ethnic postmenopausal women . ALLHAT results will include 15,133 hypertensive blacks , and AASK will have 1,094 hypertensive blacks with nephrosclerosis . ALLHAT , STOP-2 , and HYVET will include more than 5,000 persons aged 80 or more . Future trials on diabetes mellitus must be design ed to improve the representation of women and blacks Although evidence suggests that lifestyle interventions can reduce blood pressure ( BP ) and glucose levels , there is little information about the feasibility of such interventions when implemented in community setting s. This study evaluated the effectiveness of a community-based lifestyle intervention on BP and glucose in the middle-aged and older Chinese population . By using a cluster r and omisation approach , 474 participants from two communities were assigned to the intervention group which received intensive health education and behavioural intervention , or the control group which received conventional education . Linear mixed models were used to compare between-group differences on change in BP and fasting glucose after 6 , 12 and 24 months . At the 12-month follow-up , the intervention group experienced significantly reductions in systolic BP ( −4.9 vs. 2.4 mmHg ; mean difference [ MD ] −7.3 mmHg ; p < 0.001 ) , diastolic BP ( −1.9 vs. 1.9 mmHg ; MD −3.8 mmHg ; p < 0.001 ) and fasting glucose ( −0.59 vs. 0.08 mmol/L ; MD −0.67 mmol/L ; p < 0.001 ) . These differences were sustained at the 24-month follow-up . With only two communities , it was not possible to adjust for potential clustering by site . This approach of lifestyle interventions conducted through primary care services may be a potential solution for combating hypertension and diabetes in a re source -limited country context in China PURPOSE To characterize relationships between sodium and potassium intakes and blood pressure control . METHODS We analyzed repeated 24-hour diet recalls and 24-hour urine assays from 873 elderly participants with established hypertension in a 3-year clinical trial of lifestyle interventions .  Pooled estimates of electrolyte intakes were developed using hierarchical measurement error models and related to nonpharmacologic blood pressure control . RESULTS Relative decreases in sodium and increases in potassium intakes each had grade d relationships with better blood pressure control . After adjustment for measurement error , a 100 mmol/24-hour decrease in sodium intake was associated with an odds ratio of 2.93 [ 95 % confidence interval : 1.83 , 4.64 ] for maintaining nonpharmacologic blood pressure control throughout follow-up . A 50 mmol/24-hour increase in potassium intake was associated with an odds ratio of 2.00 [ 1.12 , 3.55 ] . These relationships were independent of each other and of baseline levels of intakes . Blood pressure control was most strongly associated with sodium intake for participants with lower systolic blood pressures and longer duration of hypertension , and with potassium for those with elevated diastolic blood pressures . CONCLUSIONS Sodium and potassium intakes exert independent grade d influences on nonpharmacologic blood pressure control . Correlated measurement error may spuriously introduce a dependency among these relationships IMPORTANCE Controlling glycemia , blood pressure , and cholesterol is important for patients with diabetes . How best to achieve this goal is unknown . OBJECTIVE To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 2-group unblinded r and omized trial at 4 teaching hospitals in the United States and Taiwan involving 120 participants who had a hemoglobin A1c ( HbA1c ) level of 8.0 % or higher , body mass index ( BMI ) between 30.0 and 39.9 , C peptide level of more than 1.0 ng/mL , and type 2 diabetes for at least 6 months . The study began in April 2008 . INTERVENTIONS Lifestyle-intensive medical management intervention and Roux-en-Y gastric bypass surgery . Medications for hyperglycemia , hypertension , and dyslipidemia were prescribed according to protocol and surgical techniques that were st and ardized . MAIN OUTCOMES AND MEASURES Composite goal of HbA1c less than 7.0 % , low-density lipoprotein cholesterol less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg . RESULTS All 120 patients received the intensive lifestyle-medical management protocol and 60 were r and omly assigned to undergo Roux-en-Y gastric bypass . After 12-months , 28 participants ( 49 % ; 95 % CI , 36%-63 % ) in the gastric bypass group and 11 ( 19 % ; 95 % CI , 10%-32 % ) in the lifestyle-medical management group achieved the primary end points ( odds ratio [ OR ] , 4.8 ; 95 % CI , 1.9 - 11.7 ) . Participants in the gastric bypass group required 3.0 fewer medications ( mean , 1.7 vs 4.8 ; 95 % CI for the difference , 2.3 - 3.6 ) and lost 26.1 % vs 7.9 % of their initial body weigh compared with the lifestyle-medical management group ( difference , 17.5 % ; 95 % CI , 14.2%-20.7 % ) . Regression analyses indicated that achieving the composite end point was primarily attributable to weight loss . There were 22 serious adverse events in the gastric bypass group , including 1 cardiovascular event , and 15 in the lifestyle-medical management group . There were 4 perioperative complications and 6 late postoperative complications . The gastric bypass group experienced more nutritional deficiency than the lifestyle-medical management group . CONCLUSIONS AND RELEVANCE In mild to moderately obese patients with type 2 diabetes , adding gastric bypass surgery to lifestyle and medical management was associated with a greater likelihood of achieving the composite goal . Potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies of diabetes must be weighed against the risk of serious adverse events . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00641251 OBJECTIVE : To compare the management of mild diastolic hypertension ( 90 to 104 mm Hg ) using a nonpharmacologic intervention with that using propranolol or placebo . DESIGN : R and omized , placebo-controlled trial with a 2 × 2 factorial design . SETTING : University-based ambulatory care center . PARTICIPANTS : Two hundred seven men and 105 women , 22 to 59 years of age , 73 % white , who had mild diastolic hypertension untreated for at least eight weeks . INTERVENTIONS : 1 ) a multicomponent lifestyle modification intervention ( lifestyle focus group , or LFG ) administered in eight weekly meetings+placebo , 2 ) LFG+propranolol , 3 ) propranolol alone , and 4 ) placebo alone , followed for 12 months . MEASUREMENTS : Systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and self-reported adverse effects at each of nine follow-up visits ; fasting total cholesterol , triglycerides , and glucose at baseline and 12 months ; 24-hour urine sodium ( Na+ ) and potassium ( K+ ) , three-day food records and physical activity question naire at three and 12 months ; and a quality of life question naire at 12 months . MAIN RESULTS : The mean decreases in DBP at 12 months were : 8.5 mm Hg in the LFG+propranolol group ; 7.7 mm Hg in the propranolol-only group ; 5.9 mm Hg in the placebo-only group ; and 5.4 mm Hg in the LFG+placebo group . Repeated- measures analysis of covariance showed that level of baseline DBP ( p<0.0001 ) , time of follow-up ( p<0.0001 ) , and propranolol use ( p<0.0001 ) were significantly associated with a decrease in DBP at 12 months . Despite reductions in urinary Na+ ( −35 mEq ; 95 % CI=−50 , −19 ) , dietary Na+ ( −521 mg ; 95 % CI=−710 , −332 ) , total calories ingested ( −238 ; 95 % CI=−335 , −140 ) , and weight ( −1.4 lb ; 95 % CI=−3.7 , + 0.8 ) , and significant increases in dietary K+ ( + 294 mg ; 95 % CI=+107 , + 480 ) and in mets-minutes of exercise ( + 43 ; 95 % CI=+20 , + 67 ) at three months , assignment to the LFG intervention had no effect on DBP at three or 12 months . The subjects assigned to take propranolol more frequently reported fatigue during ordinary activities , sleep disturbance , decrease in sexual activity , and depressed feelings , when compared with the subjects taking placebo , but the numbers of study withdrawals did not differ by drug assignment . No significant difference in total cholesterol and glucose levels was observed by group assignment . Triglycerides increased significantly in the subjects assigned to propranolol ( mean difference=+20 mg/dL ; 95 % CI of difference + 1.5 , + 39 ) . There was no difference in the responses to 21 quality of life items between the subjects assigned to propranolol and those assigned to placebo . CONCLUSIONS : This multicomponent lifestyle modification intervention was unable to promote persistent behavior changes and thus was inferior to propranolol therapy for the treatment for mild diastolic hypertension . Future research should focus on single modifiable factors to lower blood pressure AIMS To assess self-reported lifetime prevalence of cardiovascular disease ( CVD ) among colorectal cancer survivors , and examine the cross-sectional and prospect i ve associations of lifestyle factors with co-morbid CVD . METHODS Colorectal cancer survivors were recruited ( n=1966 ) . Data were collected at approximately 5 , 12 , 24 and 36 months post-diagnosis . Cross-sectional findings included six CVD categories ( hypercholesterolaemia , hypertension , diabetes , heart failure , kidney disease and ischaemic heart disease ( IHD ) ) at 5 months post-diagnosis . Longitudinal outcomes included the probability of developing ( de novo ) co-morbid CVD by 36 months post-diagnosis . Lifestyle factors  included  body mass index , physical activity , television ( TV ) viewing , alcohol consumption and smoking .  RESULTS Co-morbid CVD prevalence at 5 months post-diagnosis was 59 % , and 16 % of participants with no known CVD at the baseline reported de novo CVD by 36 months . Obesity at the baseline predicted de novo hypertension ( odds ratio [OR]=2.20 , 95 % confidence intervals [CI]=1.09 , 4.45 ) and de novo diabetes ( OR=6.55 , 95 % CI=2.19 , 19.53 ) . Participants watching > 4h of TV/d at the baseline ( compared with < 2h/d ) were more likely to develop ischaemic heart disease by 36 months ( OR=5.51 , 95 % CI=1.86 , 16.34 ) . CONCLUSION Overweight colorectal cancer survivors were more likely to suffer from co-morbid CVD . Interventions focusing on weight management and other modifiable lifestyle factors may reduce functional decline and improve survival Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients , blood pressure control rates remain low . In community-based primary care clinics , we performed a nested , 2 × 2 r and omized , controlled trial of physician intervention versus control and /or patient intervention versus control . Physician intervention included internet-based training , self-monitoring , and quarterly feedback reports . Patient intervention included 20 weekly group sessions followed by 12 monthly telephone counseling contacts and focused on weight loss , Dietary Approaches to Stop Hypertension dietary pattern , exercise , and reduced sodium intake . The primary outcome was change in systolic blood pressure at 6 months . Eight primary care practice s ( 32 physicians ) were r and omized to physician intervention or control groups . Within those practice s , 574 patients were r and omized to patient intervention or control groups . Patient mean age was 60 years , 61 % were women , and 37 % were black . Blood pressure data were available for 91 % of patients at 6 months . The main effect of physician intervention  on systolic blood pressure at 6 months , adjusted for baseline pressure , was 0.3 mm Hg ( 95 % CI : −1.5 to 2.2 ; P=0.72 ) . The main effect of the patient intervention was −2.6 mm Hg ( 95 % CI : −4.4 to −0.7 ; P=0.01 ) . The interaction of the 2 interventions was significant ( P=0.03 ) ; the largest impact was observed with the combination of physician and patient intervention ( −9.7±12.7 mm Hg ) . Differences between treatment groups did not persist at 18 months . Combined physician and patient interventions  lowers blood pressure ; future research should focus on enhancing effectiveness and sustainability of these interventions BACKGROUND Efficient dietary interventions for patients with hypertension in clinical setting s are needed . OBJECTIVE To assess the separate and combined influence of a physician intervention ( MD-I ) and a patient intervention ( PT-I ) on dietary intakes of patients with hypertension . DESIGN A nested 2 × 2 design , r and omized controlled trial conducted over 18 months . PARTICIPANTS A total of 32 physicians and 574 out patients with hypertension . INTERVENTION MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification . PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern , reduce sodium intake , manage weight , increase exercise , and moderate alcohol intake . MAIN OUTCOME MEASURES Dietary intakes were measured by the Block Food Frequency Question naire . Concordance with the DASH dietary pattern was estimated by a DASH score . STATISTICAL ANALYSES The main effects of MD-I and PT-I , and their interaction , were evaluated using analysis of covariance . RESULTS After 6 months of intervention , MD-I participants significantly increased intakes of potassium , fruits , juices , and carbohydrate ; decreased intake of fat ; and improved overall dietary quality as measured by the Healthy Eating Index . PT-I intervention result ed in increased intakes of carbohydrate , protein , fiber , calcium , potassium , fruits and fruit juices , vegetables , dairy and Healthy Eating Index score , and decreased intakes in fat , saturated fat , cholesterol , sodium , sweets , and added fats/oils/sweets . In addition , PT-I improved overall DASH concordance score . The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months . At 18 months , most changes reversed back toward baseline levels , including the DASH score . CONCLUSIONS Both MD-I and PT-I  improved eating patterns at 6 months with some sustained effects at 18 months . Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines , only the PT-I intervention was effective in improving the overall DASH concordance score . This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies . Furthermore , this study emphasizes the importance of collaborations among physicians , registered dietitians and other dietetics practitioners , and lay health advisors while assisting patients to make healthy behavior changes BACKGROUND Oligopinۚ ( OP ) is a quantified extract from French Maritime Pine bark ( FMPB ) with low molecular weight procyanidins . The cardioprotective effects of OP need to be tested in human clinical intervention trials with an appropriate design . PURPOSE The aim of the present study was to assess the effect of subchronic consumption of OP on cardiovascular disease risk factors such as lipid profile , systolic blood pressure ( BP ) and oxidized-Low Density Lipoprotein ( ox-LDL ) in stage-1-hypertensive subjects . METHODS Between February 14 and May 31 , 2014 , eligible subjects were recruited from the outpatient clinics of Hospital Universitari Sant Joan ( Reus , Spain ) . A total of 24 participants ( mean age ± DS ; 57.36 ± 11.25 ; 17 men ) with stage-1-hypertension who were not receiving BP-lowering medication and LDL cholesterol < 4.88 mmol/l were r and omized in a double-blind , placebo-controlled , crossover study . The subjects received 2 capsules/day with 75 mg of OP or placebo for 5-weeks . RESULTS At 5-weeks , compared to the placebo , OP  raised High Density Lipoprotein-cholesterol ( HDL-c ) by 14.06 % ( p = 0.012 ) and apolipoprotein A-1 by 8.12 % ( p = 0.038 ) and reduced the ratio of apolipoprotein B-100/A-1 by 10.26 % ( p = 0.046 ) . Moreover , at 5-weeks , compared to the baseline , OP  reduced the systolic BP by 6.36 mmHg ( p = 0.014 ) , and decreased ox-LDL concentrations by 31.72 U/l ( p = 0.015 ) . CONCLUSION At 5-weeks , the consumption of 150 mg/day of OP  improve lipid cardiovascular profile and represents one of the scarce ways to increase HDL-c in stage-1-hypertensive subjects . TRIAL REGISTRATION Clinical Trials.gov : NCT02063477 Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males OBJECTIVE To explore the sex-specific benefits and risks of treatment of stage 1 diastolic hypertension . METHODS Participants were African-American and white hypertensive men ( n = 557 ) and women ( n = 345 ) ( age range , 45 to 69 years ) with a diastolic blood pressure less than 100 mm Hg . Participants were r and omized to treatment with placebo , chlorthalidone ( 15 mg/d ) , acebutolol hydrochloride ( 400 mg/d ) , doxazosin mesylate ( 2 mg/d ) , amlodipine besylate ( 5 mg/d ) , or enalapril maleate ( 5 mg/d ) ; all were given nutritional-hygienic intervention . RESULTS After 4 years , women who were r and omized to lifestyle intervention  only were less likely to be receiving  step 1 therapy alone ( placebo ) than men who were r and omized to placebo therapy ( 46 % vs 66 % , respectively , P < .01 ) . There were significantly greater decreases in the mean systolic blood pressure in both men and women who were assigned to treatment with active drugs compared with those participants who were receiving placebo therapy ; differences among treatments with active drugs were similar between men and women . Men experienced larger falls in their total and low-density lipoprotein cholesterol and triglyceride levels regardless of the treatment assignment than did women ; however , there were no significant sex-by-treatment interactions . Quality -of-life indexes were generally improved with active drug treatment compared with placebo therapy in both sexes ; there was a sex-by-treatment interaction for the general health index . The relative risk ( RR ) for combined clinical events was similar in women ( RR , 0.64 ; 95 % confidence interval [ CI ] , ( 0.36 to 1.16 ) and in men ( RR , 0.67 ; 95 % CI , 0.40 to 1.14 ) who were assigned to treatment with all active drugs combined , compared with those who were receiving placebo therapy . CONCLUSION In these exploratory analyses , men and women who were assigned to treatment with active drugs experienced greater and generally similar benefits from treatment than those participants who were assigned to lifestyle intervention only BACKGROUND Accumulating evidence implicates a role of Mg(2 + ) in the pathophysiology of essential hypertension . Previous studies evaluating the antihypertensive efficacy of Mg(2 + ) supplementation gave contradictory results . This study aim ed to investigate the effect of oral Mg(2 + ) supplementation on 24-h blood pressure ( BP ) and intracellular ion status in patients with mild hypertension . METHODS A total of 48 patients with mild uncomplicated hypertension participated in the study . Among them , 24 subjects were assigned to 600 mg of pidolate Mg(2 + ) daily in addition to lifestyle recommendations for a 12-week period and another 24 age- and sex-matched controls were only given lifestyle recommendations . At baseline and study -end ( 12 weeks ) ambulatory BP monitoring , determination of serum and intracellular ion levels , and 24-h urinary collection s for determination of urinary Mg(2 + ) were performed in all study subjects . RESULTS In the Mg(2 + ) supplementation group , small but significant reductions in mean 24-h systolic and diastolic BP levels were observed , in contrast to control group ( -5.6 + /- 2.7 vs. -1.3 + /- 2.4 mm Hg , P < 0.001 and -2.8 + /- 1.8 vs. -1 + /- 1.2 mm Hg , P = 0.002 , respectively ) . These effects of Mg(2 + ) supplementation were consistent in both daytime and night-time periods . Serum Mg(2 + ) levels and urinary Mg(2 + ) excretion were significantly increased in the intervention group . Intracellular Mg(2 + ) and K(+ ) levels were also increased , while intracellular Ca(2 + ) and Na(+ ) levels were decreased in the intervention group . None of the intracellular ions were significantly changed in the control group . CONCLUSION This study suggests that oral Mg(2 + ) supplementation is associated with small but consistent ambulatory BP reduction in patients with mild hypertension Introduction Self-management of hypertension , including self-monitoring and antihypertensive medication titration , lowers blood pressure ( BP ) at 1 year compared to usual care . The aim of the current trial is to assess the effectiveness of the Home and Online Management and Evaluation of Blood Pressure ( HOME BP ) intervention for the self-management of hypertension in primary care . Methods and analysis The HOME BP trial will be a r and omised controlled trial comparing BP self-management — consisting of the HOME BP online digital intervention with self-monitoring , lifestyle advice and antihypertensive drug titration — with usual care for people with uncontrolled essential hypertension . Eligible patients will be recruited from primary care and r and omised to usual care or to self-management using HOME BP . The primary outcome will be the difference in mean systolic BP ( mm Hg ) at 12-month follow-up between the intervention and control groups adjusting for baseline BP and covariates . Secondary outcomes ( also adjusted for baseline and covariates where appropriate ) will be differences in mean BP at 6 months and diastolic BP at 12 months ; patient enablement ; quality of life , and economic analyses including all key re sources associated with the intervention and related services , adopting a broad societal perspective to include NHS , social care and patient costs , considered within trial and modelled with a lifetime horizon . Medication beliefs , adherence and changes ; self-efficacy ; perceived side effects and lifestyle changes will be measured for process analyses . Qualitative analyses will explore patient and healthcare professional experiences of HOME BP to gain insights into the factors affecting acceptability , feasibility and adherence . Ethics and dissemination This study has received NHS ethical approval ( REC reference 15/SC/0082 ) . The findings from HOME BP will be disseminated widely through peer- review ed publications , scientific conferences and workshops . If successful , HOME BP will be directly applicable to UK primary care management of hypertension . Trial registration number IS RCT N13790648 ; pre- results BACKGROUND Despite the promising findings from short-term intervention trials , the long-term effect of habitual fruit and vegetable intake on blood pressure ( BP ) remains uncertain . We therefore assessed the prospect i ve association between baseline intake of fruits and vegetables and the risk of hypertension in a large cohort of middle-aged and older women . METHODS We conducted analyses among 28,082 US female health professionals aged ≥39 years , free of cardiovascular disease , cancer , and hypertension at baseline .  Baseline intake of fruits and vegetables was assessed using semiquantitative food frequency question naires ( FFQs ) . Incident hypertension was identified from annual follow-up question naires . RESULTS During 12.9 years of follow-up , 13,633 women developed incident hypertension . After basic adjustment including age , race , and total energy intake , the hazard ratio ( HR ) and 95 % confidence interval ( CI ) of hypertension was 0.97 ( 0.89 - 1.05 ) , 0.93 ( 0.85 - 1.01 ) , 0.89 ( 0.82 - 0.97 ) , and 0.86 ( 0.78 - 0.94 ) comparing women who consumed 2- < 4 , 4- < 6 , 6- < 8 , and ≥8 servings/day of total fruits and vegetables with those consuming < 2 servings/day . These associations did not change after additionally adjusting for lifestyle factors but were attenuated after further adjustment for other dietary factors . When fruits and vegetables were analyzed separately , higher intake of all fruits but not all vegetables remained significantly associated with reduced risk of hypertension after adjustment for lifestyle and dietary factors . Adding body mass index ( BMI ) to the models eliminated all associations . CONCLUSIONS Higher intake of fruits and vegetables , as part of a healthy dietary pattern , may only contribute a modest beneficial effect to hypertension prevention , possibly through improvement in body weight regulation Background In Shanghai there are 1.2 million people with hypertension , many of whom have difficulty in affording medical treatment . Community based , anti-hypertensive clubs have been created to provide health education but education alone is often ineffective . Lifestyle change programmes have shown some potential for reducing blood pressure but in previous trials have required specialist staff and extensive contact . We have previously demonstrated that self-management programmes delivered by health professionals , such as a nurse who has had short training in self-management techniques can change health behaviour and reduce symptoms . This study was design ed to evaluate the benefits of a simple , cognitive-behavioural , self-management programme for hypertension based around a hypertension manual and delivered in the setting of a community anti-hypertensive club in Shanghai . Method The method was a pragmatic r and omised controlled trial with an intention-to-treat analysis . Adult patients with mild-to-moderate primary hypertension , waiting to join a neighbourhood anti-hypertension club , were r and omised to the self-management programme or to an information only control procedure . They attended the group treatment sessions on 4 occasions over 5 weeks for education combined with goal setting for lifestyle change and an introduction to exercise . The main outcome measures were : changes in blood pressure ; blood total cholesterol ; diet ; activity level and health related quality of life 1 month and 4 months after the end of treatment . Results A total of 140 adults with mild-to-moderate primary hypertension took part . All of the main outcomes showed beneficial changes . Four months after the end of treatment the mean blood pressure differences between groups were systolic 10.15 mm Hg ( P < 0.001 , 95 % CI 7.25–13.05 ) , and diastolic 8.29 mmHg ( P < 0.001 , 95 % CI 6.71–9.88 ) . Patients in the intervention group also had significantly reduced weight , lowered blood total cholesterol , increased physical activity and improved quality of life . Conclusion Patients with mild-to-moderate primary hypertension attending a 5 week , group and manual based , cognitive-behavioural self-management programme , delivered through a voluntary club in Shanghai experienced a significant reduction in blood pressure . Trial registration Current Controlled Trials IS RCT Background African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease . Psychosocial stress , lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease . This study evaluated effects of stress reduction and lifestyle modification on blood pressure , telomerase gene expression and lifestyle factors in African Americans . Methods Forty-eight African American men and women with stage I hypertension who participated in a larger r and omized controlled trial volunteered for this sub study . These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course ( SR ) or an extensive health education program ( EHE ) for 16 weeks . Primary outcomes were telomerase gene expression ( hTERT and hTR ) and clinic blood pressure . Secondary outcomes included lifestyle-related factors . Data were analyzed for within-group and between-group changes . Results Both groups showed increases in the two measures of telomerase gene expression , hTR mRNA levels ( SR : p < 0.001 ; EHE : p < 0.001 ) and hTERT mRNA levels ( SR : p = 0.055 ; EHE : p < 0.002 ) . However , no statistically significant between-group changes were observed . Both groups showed reductions in systolic BP . Adjusted changes were SR = -5.7 mm Hg , p < 0.01 ; EHE = -9.0 mm Hg , p < 0.001 with no statistically significant difference between group difference . There was a significant reduction in diastolic BP in the EHE group ( -5.3 mm Hg , p < 0.001 ) but not in SR ( -1.2 mm Hg , p = 0.42 ) ; the between-group difference was significant ( p = 0.04 ) . The EHE group showed a greater number of changes in lifestyle behaviors . Conclusion In this pilot trial , both stress reduction ( Transcendental Meditation technique plus health education ) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP . The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP . Trial Registration Clinical Trials.gov In a r and omized , single-blind , controlled trial , 621 patients were assigned either intervention diet A ( group A , 310 patients ) or control diet B  ( group B , 311 patients ) for a period of 24 weeks . After 24 weeks as revealed by dietary question naires , group A patients received : ( 1 ) a diet with a higher percentage of calories from fruits and vegetables and complex carbohydrates ; ( 2 ) a higher polyunsaturated/saturated fat ratio diet ; and ( 3 ) a larger amount of soluble dietary fiber , antioxidant vitamins and minerals and low saturated fat and cholesterol than group B. Group A patients also did more physical and yogic exercises than group B. Adherence to diet and exercise was obtained through question naires and information obtained was quantified into a formula . After 24 weeks , the overall score of diet and exercises  was significantly higher in group A than in group B. There was a significant decrease in serum total cholesterol ( 13.3 % ) , low-density lipoprotein cholesterol ( 16.9 % ) , triglycerides ( 19.2 % ) , fasting blood glucose ( 19.5 % ) and blood pressures ( 11.5/6.2 mm Hg ) in the intervention group compared with initial levels and changes in group B. The effect of  exercise  on the decrease in risk factors was additive . Within group A , overall score for diet and exercise  was greater in 1 subset of 116 patients in the intervention group which had maximal lifestyle changes . A separate analysis of data in this subgroup revealed a greater decrease in risk factors compared with risk factor changes in the remaining 194 patients with less higher overall score ; this indicated that the relation of lifestyle changes with reduction in risk factors may be of causal nature . ( ABSTRACT TRUNCATED AT 250 WORDS To examine the long-term effects of weight loss and dietary sodium reduction on the incidence of hypertension , we studied 181 men and women who participated in the Trials of Hypertension Prevention , phase 1 , in Baltimore , Md. At baseline ( 1987 to 1988 ) , subjects were 30 to 54 years old and had a diastolic blood pressure ( BP ) of 80 to 89 mm Hg and systolic BP < 160 mm Hg . They were r and omly assigned to one of two 18-month lifestyle modification interventions aim ed at either weight loss or dietary sodium reduction or to a usual care control group . At the posttrial follow-up ( 1994 to 1995 ) , BP was measured by blinded observers who used a r and om-zero sphygmomanometer . Incident hypertension was defined as systolic BP > or = 160 mm Hg and /or diastolic BP > or = 90 mm Hg and /or treatment with antihypertensive medication during follow-up . Body weight and urinary sodium were not significantly different among the groups at the posttrial follow-up . After 7 years of follow-up , the incidence of hypertension was 18.9 % in the weight loss group and 40.5 % in its control group and 22.4 % in the sodium reduction group and 32.9 % in its control group . In logistic regression analysis adjusted for baseline age , gender , race , physical activity , alcohol consumption , education , body weight , systolic BP , and urinary sodium excretion , the odds of hypertension was reduced by 77 % ( odds ratio 0.23 ; 95 % confidence interval 0.07 to 0.76 ; P=0.02 ) in the weight loss group and by 35 % ( odds ratio 0.65 ; 95 % confidence interval 0.25 to 1.69 ; P=0.37 ) in the sodium reduction group compared with their control groups . These results indicate that lifestyle modification such as weight loss may be effective in long-term primary prevention of hypertension Background Health promotion is a key component for primary prevention of cardiovascular disease ( CVD ) . This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors ( CVDRF )  in the general population in the context of a community-based programme on hypertension management . Methods A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009 . In the intervention commune , a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated , while no new programme , apart from conventional healthcare services , was provided in the reference commune . Health promotion campaigns focused on smoking cessation , reducing alcohol consumption , encouraging physical activity and reducing salty diets . Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure ( BP ) and behavioural CVDRFs ( smoking , alcohol consumption , physical inactivity and salty diet ) in both communes before and after the 3-year intervention . Results Overall 4,650 adults above 25 years old were surveyed , in four r and omly independent sample s covering both communes at baseline and after the 3-year intervention . Although physical inactivity and obesity increased over time in the intervention commune , there was a significant reduction in systolic and diastolic BP ( 3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively ) in the general population at the intervention commune . Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption . Conclusion Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span . Limited effects on a context -bound CVDRF like smoking suggested that higher intensity of intervention , a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention Context Can adults make sustained changes in unhealthy lifestyle behaviors ? Content In this multicenter trial , 810 adult volunteers with prehypertension or stage 1 hypertension were r and omly assigned to a multicomponent behavioral intervention group , a group combining the behavioral intervention plus the Dietary Approaches to Stop Hypertension ( DASH ) diet , or an advice only group . At 18 months , participants in both behavioral intervention groups had less hypertension , more weight loss , and better reduction in sodium and fat intake than those receiving advice only . The participants in the DASH diet group also increased their intake of fruits , vegetables , and fiber . Implication s Motivated adults can sustain several lifestyle changes over 18 months , which might reduce their risk for cardiovascular disease . The Editors The public health burden of chronic diseases related to suboptimal diet and physical inactivity is enormous . It has been estimated that these lifestyle factors contribute to approximately 20 % of deaths in the United States ( 1 ) . Incidence of atherosclerotic cardiovascular disease , overweight and obesity , elevated blood pressure and lipid levels , diabetes , osteoporosis , and cancer is increased by unhealthy lifestyles ( 2 - 8 ) . Multiple lifestyle factors , such as physical inactivity ; excessive intake of calories , sodium , saturated fat , and cholesterol ; and inadequate intake of fruits , vegetables , and low-fat dairy products , are etiologically related to the development of these diseases ( 4 , 5 , 8 - 10 ) . To reduce the burden of chronic disease , increased physical activity and changes in diet are needed , yet few intervention studies have attempted to achieve many lifestyle changes simultaneously . The PREMIER r and omized trial tested the effects of 2 multicomponent behavioral interventions on blood pressure ( 11 ) . Both interventions promoted increased physical activity , weight loss , and reduced sodium intake , each of which is recommended by the 2005 Dietary Guidelines Scientific Advisory Committee ( 12 ) . One intervention also added the Dietary Approaches to Stop Hypertension ( DASH ) diet ( 13 ) . This diet , which is high in fruits , vegetables , and low-fat dairy products and low in saturated fat , total fat , and cholesterol , meets each of the major nutrient recommendations that were established by the Institute of Medicine ( 14 - 18 ) . We report the effects of the PREMIER interventions on lifestyle changes and blood pressure status at 18 months . The main results of PREMIER , namely change in blood pressure at 6 months , were reported previously ( 11 ) . Methods The PREMIER study design and rationale ( 19 ) and intervention methods ( 11 ) have been described previously . The institutional review boards at each clinical center ; an external protocol review committee appointed by the National Heart , Lung , and Blood Institute ( NHLBI ) ; and the NHLBI review ed and approved the protocol ( available at www.kpchr.org/public/premier/intervention/default.asp ) . The NHLBI also appointed a data and safety monitoring board to monitor the trial . Each participant provided written informed consent . The trial was conducted from January 2000 through November 2002 . Study Participants Participants were generally healthy adults , age 25 years or older , who had prehypertension or stage 1 hypertension and met the Joint National Committee VI ( JNC VI ) criteria for a 6-month trial of nonpharmacologic therapy ( 2 ) . Targeted recruitment methods were used to ensure adequate representation of clinical ly important subgroups , in particular , African-American persons . Specific methods varied from site to site but included direct mailings , radio and newspaper advertisements , and networking within the local African-American communities . Eligibility criteria included not taking antihypertensive medication and having a systolic blood pressure of 120 to 159 mm Hg and a diastolic blood pressure of 80 to 95 mm Hg , based on the average of 3 screening visits . Persons with prehypertension ( systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg ) were included because of the excess risk for cardiovascular disease in those with blood pressure within this range ( 20 ) . Major exclusion criteria were a body mass index less than 18.5 kg/mg2 or greater than 45.0 kg/m2 , use of antihypertensive drugs or other drugs that affect blood pressure , JNC VI risk category C ( target organ damage or diabetes ) , use of prescription weight loss medications , previous cardiovascular event , congestive heart failure , angina , cancer , and consumption of more than 21 alcoholic drinks per week . Trial Conduct Eligible participants were r and omly assigned , with equal probability , to 1 of 3 groups : an advice only comparison group ( advice only ) ; an intervention group that targeted established , guideline -recommended lifestyle recommendations ( established ) ( 2 ) ; or an intervention group targeting the established recommendations and adding the DASH dietary pattern ( established plus DASH ) ( 13 ) . Computer-generated treatment assignments were stratified by clinic and hypertension status and were assigned in blocks of varying sizes to provide balance over time . The actual assignments were administered by using a password-protected , Web-based application developed by the coordinating center and accessible only by authorized individuals . All clinic measurement staff were blinded to treatment assignment , and all intervention staff were blinded to clinic measurements . Hypertension was defined by using the JNC VI criteria for hypertension treatment : an average systolic blood pressure of 140 mm Hg , a diastolic blood pressure greater than 90 mm Hg , or use of antihypertensive medication . Normal blood pressure was defined as systolic blood pressure less than 120 mm Hg , diastolic blood pressure less than 80 mm Hg , and no use of antihypertensive medication ( 21 ) ( Figure ) . Intervention was provided by master 's degreelevel counselors ( dietitians and health educators trained in behavioral methods ) . The counselors were central ly trained before the start of the study , attended annual 3-day training sessions , and participated in monthly conference calls . Figure . Flow diagram of enrollment , measurements , and visit completion . Advice Only  Group Participants in the advice group  received advice to follow the National High Blood Pressure Education Program lifestyle recommendations for blood pressure control ( 2 ) . Lifestyle recommendations included reducing weight ( if overweight ) , following a reduced-sodium diet , engaging in regular moderate-intensity physical activity , and eating a heart-healthy diet , including the DASH diet . This advice was provided in two 30-minute individual sessions , 1 immediately after r and om assignment and 1 after the 6-month data collection visit . A PREMIER counselor review ed the guidelines with the participant and provided printed educational material s and information about community re sources . This intervention did not include advice to keep a food or exercise diary . Behavioral Interventions in the Established and Established plus DASH Groups Participant goals for the established and established plus DASH groups included weight loss of at least 6.8 kg ( 15 lb ) for those with a body mass index of 25 kg/m2 or greater , at least 180 minutes per week of moderate-intensity physical activity , no more than 100 mmol per day of dietary sodium , and alcohol consumption of no more than 30 mL ( 1 oz ) per day ( 2 drinks ) for men and 15 mL ( 0.5 ) oz per day ( 1 drink ) for women . Participants assigned to the established plus DASH group ( but not those in the established group ) also received counseling on the DASH diet , with goals for increased consumption of fruits and vegetables ( 9 to 12 servings/d ) and low-fat dairy products ( 2 to 3 servings/d ) and reduced consumption of saturated fat ( 7 % of energy ) and total fat ( 25 % of energy ) . The intervention format , contact pattern , and behavior change strategies for the established and established plus DASH groups were identical . During the first 6 months , participants in both behavioral intervention groups attended 14 group sessions and 4 individual sessions ; during months 7 to 18 , they attended monthly group sessions supplemented with 3 individual counseling sessions . Throughout the trial , participants in the established and established plus DASH groups ( but not those in the advice group ) kept food diaries , monitored dietary calorie and sodium intakes , and recorded minutes of physical activity . Self-monitoring was used to provide individualized feedback , reinforcement , problem solving , and support . Social support for initial behavior changes and maintenance of change was provided during the group sessions . More detailed descriptions of the behavorial intervention methods are available ( 22 ) . Measurements Blood pressure was assessed twice at each measurement , and systolic and diastolic blood pressures were calculated by using the mean of all available measurements ( 4 sets before r and om assignment , 3 sets at 6 and 18 months , and 1 set at 3 and 12 months ) . For 4 participants who were started on antihypertensive drug therapy between the 12- and 18-month visits , we obtained an official set of blood pressure measurements before initiation of therapy and used these as our 18-month blood pressure values for analysis . A similar procedure was used to obtain the 6-month blood pressure value for the 1 participant who began taking antihypertensive drugs between the 3- and 6-month visits . Two 24-hour dietary recalls , 1 obtained on a weekday and the other obtained on a weekend , were collected at baseline and at 6 and 18 months by telephone interview ( 23 ) . Intakes of nutrients and food groups were calculated by using the Nutrition Data System for Research , version NDS-R 1998 ( University of Minnesota , Minneapolis , Minnesota ) . Urinary excretion of sodium ( reflecting salt intake ) and potassium ( reflecting fruit and vegetable intake ) was obtained from 24-hour urinary collection s at baseline Background : The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease ( CHD )  among postmenopausal women with diabetes . Purpose : Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes . Methods : Participants ( N = 279 ) were r and omized to usual care ( UC ) or Mediterranean Lifestyle Program , a lifestyle change intervention aim ed at the behavioral risk factors ( eating patterns , physical activity , stress management , and social support ) affecting risk for CHD in postmenopausal women with type 2 diabetes . Results : In original and intent-to-treat analyses ,  Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors , physical activity , stress management , perceived support , and weight loss at 6 months compared to UC . Conclusions : This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes , showed that postmenopausal women could make comprehensive lifestyle changes , and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors Lifestyle modifications , such as weight loss , sodium restriction , and limiting alcohol consumption , are important components of the initial treatment of hypertensive patients . The Dietary Approaches to Stop Hypertension ( DASH ) study investigated the effects of dietary patterns on blood pressure in individuals with diastolic blood pressure between 80 - 95 mmHg . Two different dietary patterns were tested in this feeding study . A diet enriched in fruits and vegetables and a diet enriched in fruits , vegetables , and low-fat dairy products and low in total and saturated fat ( combination diet ) were compared with a control diet . Dietary intake was adjusted so that participants did not lose weight , and all study diets had comparable sodium intake ( approximately 3 grams/day ) . All meals were provided for 459 participants for an 11-week period . Those r and omized to the combination diet ( n = 151 ) had a significant change in systolic ( -5.5 mmHg ; p < 0.001 ) and diastolic blood pressure ( -3.0 mmHg ; p < 0.001 ) after subtracting the response to the control diet ( n = 154 ) . The fruits- and -vegetables diet ( n = 154 ) produced a significant but lesser decrease in blood pressure ( systolic , -2.8 mmHg ; p < 0.001 and diastolic , -1.1 mmHg ; p = 0.07 ) . Hypertensive individuals and African Americans had particularly favorable responses with blood pressure reductions , which were significantly greater than other subgroups . The combination diet was well-accepted and adherence to the diet was high ( > 90 % ) for all participants . The DASH combination diet is an effective lifestyle modification for lowering blood pressure in patients with high-normal or Stage 1 hypertension Purpose The purpose of this article is to describe efforts to develop and administer a formal curriculum to train community workers to deliver a group-based adaptation of the Diabetes Prevention Program ( DPP ) lifestyle intervention in YMCA setting s. The DPP demonstrated that a structured diet and physical activity intervention that achieves and maintains modest weight loss for overweight adults with impaired glucose tolerance can significantly reduce the development of diabetes . Although tens of millions of American adults could benefit from access to the DPP lifestyle intervention , there currently is no available model for nationwide dissemination of this highly beneficial and cost-effective approach to diabetes prevention . A description of 2 ongoing r and omized pilot studies provides information about the feasibility and effectiveness of future efforts to apply this new training curriculum on a national scale . Conclusions Diabetes educators are challenged to partner with community organizations and other health care workers for extensive distribution of the DPP lifestyle intervention messages Abstract Background : This study assessed effects of acupuncture as an add-on to conventional antihypertensive managements such as medication or lifestyle modification for hypertensive or pre-hypertensive subjects . Methods : A r and omized , double-blind , placebo-controlled trial was conducted at Kyung Hee University Hospital . Forty-one hypertensive or pre-hypertensive ( systolic BP≥120 mmHg or diastolic BP≥80 mmHg ) volunteers were recruited and r and omly assigned into real or sham acupuncture groups . The hypertensive subjects on antihypertensive medication continued their medication . Acupuncture point prescriptions were partially individualized , based on the Saam acupuncture theory . Park 's sham needle method was adopted for the sham procedure . Measurements were performed at baseline , weeks 4 and 8 . BP , scales of overall health and pain , and anticipation or satisfaction for the treatments , were recorded . Results : Thirty subjects completed the intervention , all of whom were on antihypertensive medication . The sham acupuncture group showed no significant change in mean BP , while the real acupuncture group showed a significant ( p<0.01 ) decrease in mean BP after 8 weeks of intervention from 136.8/83.7 to 122.1/76.8 mmHg . Other factors showed no difference between the groups throughout the study . Conclusion : Acupuncture seems to offer an additional benefit to the treatment of hypertensive patients BACKGROUND Our objective was to quantify and predict diabetes risk reduction during the Diabetes Prevention Program Outcomes Study ( DPPOS ) in participants who returned to normal glucose regulation at least once during the Diabetes Prevention Program ( DPP ) compared with those who consistently met criteria for prediabetes . METHODS DPPOS is an ongoing observational study of participants from the DPP r and omised trial . For this analysis , diabetes cumulative incidence in DPPOS was calculated for participants with normal glucose regulation or prediabetes status during DPP with and without stratification by previous r and omised treatment group . Cox proportional hazards modelling and generalised linear mixed models were used to quantify the effect of previous ( DPP ) glycaemic status on risk of later ( DPPOS ) diabetes and normal glucose regulation status , respectively , per SD in change . Included in this analysis were 1990 participants of DPPOS who had been r and omly assigned to treatment groups during DPP ( 736 intensive lifestyle intervention , 647 metformin , 607 placebo ) . These studies are registered at Clinical Trials.gov , NCT00004992 ( DPP ) and NCT00038727 ( DPPOS ) . FINDINGS Diabetes risk during DPPOS was 56 % lower for participants who had returned to normal glucose regulation versus those who consistently had prediabetes ( hazard ratio [ HR ] 0·44 , 95 % CI 0·37 - 0·55 , p<0·0001 ) and was unaffected by previous group assignment ( interaction test for normal glucose regulation and lifestyle intervention , p=0·1722 ; normal glucose regulation and metformin , p=0·3304 ) . Many , but not all , of the variables that increased diabetes risk were inversely associated with the chance of a participant reaching normal glucose regulation status in DPPOS . Specifically , previous achievement of normal glucose regulation ( odds ratio [ OR ] 3·18 , 95 % CI 2·71 - 3·72 , p<0·0001 ) , increased β-cell function ( OR 1·28 ; 95 % CI 1·18 - 1·39 , p<0·0001 ) , and insulin sensitivity ( OR 1·16 , 95 % CI 1·08 - 1·25 , p<0·0001 ) were associated with normal glucose regulation in DPPOS , whereas the opposite was true for prediction of diabetes , with increased β-cell function ( HR 0·80 , 95 % CI 0·71 - 0·89 , p<0·0001 ) and insulin sensitivity ( HR 0·83 , 95 % CI 0·74 - 0·94 , p=0·0001 ) having a protective effect . Among participants who did not return to normal glucose regulation in DPP , those assigned to the intensive lifestyle intervention had a higher diabetes risk ( HR 1·31 , 95 % CI 1·03 - 1·68 , p=0·0304 ) and lower chance of normal glucose regulation ( OR 0·59 , 95 % CI 0·42 - 0·82 , p=0·0014 ) than did the placebo group in DPPOS . INTERPRETATION We conclude that prediabetes is a high-risk state for diabetes , especially in patients who remain with prediabetes despite intensive lifestyle intervention . Reversion to normal glucose regulation , even if transient , is associated with a significantly reduced risk of future diabetes independent of previous treatment group . FUNDING US National Institutes of Health Lowering blood pressure ( BP ) in stroke survivors reduces the risk of recurrent stroke . We tested the hypothesis that a nurse-led nonpharmacologic intervention would lower the BP of participants in an intervention group compared with a control group . A total of 349 patients who had sustained acute stroke or transient ischemic attack were r and omly assigned to either usual care or to 4 home visits by a nurse . During the visits , the nurse measured and recorded BP and provided individually tailored counseling on a healthy lifestyle . A total of 303 patients completed the 1-year follow up . No change in systolic BP was noted in either the intervention group or the control group . Because of an increase in diastolic BP in the control group ( P = .03 ) , a difference in mean diastolic BP between the 2 groups was found at follow-up ( P = .007 ) . Mean BP at follow-up was 139/82 mm Hg in the intervention group and 142/86 mm Hg in the control group . Linear regression analysis demonstrated that BP at the point of discharge was the strongest predictor of BP 1 year later ( P < .0001 ) . The proportion of patients on antihypertensive medication increased in the intervention group ( P = .002 ) . Patients were compliant with antihypertensive therapy , and 92 % of the hypertensive patients in the intervention group followed the advice to see a general practitioner ( GP ) for BP checkups . At follow-up , 187 patients ( 62 % ) were hypertensive , with no difference in the rate of hypertension seen between the groups . Our data indicate that home visits by nurses did not result in a lowering of BP . Patients complied with antihypertensive therapy and GP visits in the case of hypertension . Nonetheless , the majority of patients were hypertensive at the 1-year follow up We aim ed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth , Australia . We collected data at baseline , 4 months ( post-intervention ) and 1-year follow-up in a r and omized controlled trial of a program that focused on  weight loss , diet , and exercise . Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits . Outcomes examined were saturated fat intake ( % energy ) and physical activity ( hours per week ) . In total , 90/118 individuals r and omized to usual care and 102/123 to the program-completed follow-up . Sex was a moderator of response post-intervention for diet and physical activity , with a greater response among women with usual care and among men with the program .  Change in self-efficacy was a mediator of dietary change post-intervention [ effect size ( ES ) -0.055 , 95 % confidence interval ( CI ) -0.125 , -0.005 ] and at follow-up ( ES 0.054 , 95 % CI -0.127 , -0.005 ) , and in physical activity post-intervention ( ES 0.059 , 95 % CI 0.003 , 0.147 ) . These findings highlight different responses of men and women to the program , and the importance of self-efficacy as a mediator . Mediators for physical activity in the longer term should be investigated in other models , with appropriate cognitive measurements , in future trials BACKGROUND Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes . Although most guidance on pregnancy weight is focused on the prepregnancy period , pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health . METHODS The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index ( BMI ) > 35 kg m(-2 ) to take part in a programme of health education around diet and exercise , accompanied by one-to-one guidance and monitoring of dietary change . This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors ( intervention ) versus a group of 89 women who chose not to attend ( non-intervention ) . RESULTS Mean ( SD ) weight gain in the intervention group [ 4.5 ( 4.6 ) kg ] was less than in the non-intervention group [ 10.3 ( 4.4 ) kg ] between antenatal booking and 36 weeks of gestation ( < 0.001 ) . This was associated with a 95 % reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications . There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage ( reduced by 55 % ) . The impact of the intervention on gestational weight gain was greater in women with BMI > 40 kg m(-2 ) at booking . There were no adverse effects of the intervention , even though 21 % of the intervention group lost weight during their pregnancy . CONCLUSIONS Intensive , personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy PURPOSE Home blood pressure ( BP ) monitoring is increasingly prevalent . The Canadian Hypertension Education Program ( CHEP ) developed a Family Practice BP tracking diary for home readings with an educational booklet . We evaluated the effectiveness of these tools compared with the st and ard approach of a hypertension information leaflet on BP-related knowledge , attitudes and behaviours of hypertensive family practice patients . METHOD Single-blind r and omized control trial on patients with raised BP . RESULTS Three practice s in Ontario , Quebec and Nova Scotia recruited a total of 109 eligible patients . The average age was 66.1 ( SD 9.3 ) years and 58 ( 54.7 % ) were male . There was a statistically significant increase in the mean number of correct responses to 20 hypertension knowledge questions of 1.14 from 15.3 ( SD 2.2 ) at baseline to 16.4 ( SD 2.2 ) at 3 months in both groups ( n=72 , P<0.001 ) . Patients frequently did not realize that usually more than one drug plus lifestyles changes were necessary to reduce BP to target or that it might take 6 weeks for some drugs to achieve their full effect . The BP tracking diary and the booklet had positive evaluation from the patients . CONCLUSIONS Most patients have a good baseline of knowledge about hypertension but there are still important areas that need to be addressed . The booklet and tracker were well received by patients but the simple leaflet was as effective at improving knowledge A population -based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status , body mass index ( BMI ) , obesity , diabetes mellitus ( DM ) , and hypertension , in order to gain a better underst and ing of factors influencing chronic diseases in Barbados . A systematic sampling from a r and om start technique was used to select participants for the study . A st and ard question naire was used to collect data on demographic and lifestyle characteristics , to record anthropometrics and blood pressure measurements , and to ascertain the hypertension and diabetes status of participants . The sample population consisted of 407 Barbadian Seventh-Day Adventists ( SDAs ) , who ranged in age from 25 to 74 years . One hundred fifty-three ( 37.6 % ) participants were male , and 254 ( 62.4 % ) were female , and 43.5 % were vegetarians . The prevalence rates of diabetes and hypertension were lower among long-term vegetarians , compared to non-vegetarians , and long-term vegetarians were , on average , leaner than non-vegetarians within the same cohort . A significant association was observed between a vegetarian diet and obesity ( vegetarian by definition P=.04 , self-reported vegetarian P=.009 ) in this population . Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity , diabetes , and hypertension Background / Objectives : Lifestyle habits , vascular function and inflammation are components in the development of cardiovascular disease ( CVD ) . We investigated whether simple advice on dietary and exercise habits given ( at a single time point ) to hypercholesterolemic men affects circulating biomarkers of inflammation and vascular adhesion . Subjects/ Methods : In total , 157 men ( age 46±5 years ) with mild hypercholesterolemia were r and omized to four intervention groups , diet ( D , n=40 ) , exercise ( E , n=39 ) , diet and exercise ( DE , n=39 ) or controls ( C , n=39 ) and serum concentrations of C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , soluble intercellular adhesion molecule 1 ( sICAM-1 ) , soluble vascular cell adhesion molecule 1 ( sVCAM-1 ) and soluble E-selectin ( sE-selectin ) were quantified at baseline and after a 6-month intervention period . Results : The intervention applied in this study , that is , simple advice on lifestyle changes given at a single time point , had a modest effect on inflammatory biomarkers and soluble vascular adhesion molecules . The most apparent alterations were found for individuals in group DE , who responded with significant reductions in sICAM-1 , −28 ( −41 to −14 μg/l ) and sE-selectin , −3.6 ( −6.9 to −0.3 μg/l ) after 6 months . None of the groups had altered their concentrations of sVCAM-1 , CRP or IL-6 significantly after the intervention . In all individuals combined , we found changes in apolipoprotein B ( apoB ) to predict alterations in sICAM-1 ( β=0.21 ) and sE-selectin ( β=0.26 ) , independently of changes in inflammation and other adhesion molecules . Conclusions : These observations indicate that even small efforts to improve diet and physical activity can influence biomarkers of vascular function in individuals at increased risk for CVD . ApoB was identified as an important determinant of this improvement , which adds further support to the notion of apoB as a critical target in cardiovascular prevention The Chinese Hypertension Intervention Efficacy Study ( CHIEF ) is a multi-centre r and omized controlled clinical trial comparing the effects of amlodipine+angiotensin II receptor blocker and amlodipine+diuretics on the incidence of cardiovascular events , represented as a composite of non-fatal stroke , non-fatal myocardial infa rct ion and cardiovascular death events in high-risk Chinese hypertensive patients . The study also evaluates the long-term effects of  lipid-lowering treatment and lifestyle modification .  From October 2007 to October 2008 , 13 542 patients were enrolled into the study in 180 centres in China . Patients will be followed up for 4 years . There was no difference in baseline characteristics between the two blood pressure arms STUDY QUESTION Do paternal and maternal lifestyle factors influence the risk of hypertensive pregnancy complications , gestational diabetes mellitus ( GDM ) , spontaneous preterm birth and small-for-gestational-age ( SGA ) ? SUMMARY ANSWER Paternal lifestyle factors do not exert an independent effect on the investigated outcomes while maternal prepregnancy BMI and maternal smoking during pregnancy influence the risk of hypertensive pregnancy complications , GDM and SGA . WHAT IS KNOWN ALREADY Maternal lifestyle factors are associated with perinatal complications , but the impact of paternal lifestyle factors is unclear . STUDY DESIGN , SIZE , DURATION Data from the GECKO ( Groningen Expert Center for Kids with Obesity ) Drenthe cohort , a prospect i ve population -based birth-cohort of children born between April 2006 and April 2007 in a northern province of The Netherl and s , were analysed . The parents of 2958 children ( 62 % of those approached ) gave their consent to participate in the study and the data of 2264 ( 77 % ) couples were available for analysis . PARTICIPANTS / MATERIAL S , SETTING S , METHOD All pregnant women in the Dutch province of Drenthe with an expected date of delivery between April 2006 and April 2007 were invited to participate and included during the third trimester of their pregnancy or within 6 months after delivery . All consenting couples received extensive question naires including lifestyle , biological and socio-demographic-related questions covering the period of 6 months prior to conception . Outcome data were obtained from midwives and hospital registries . Univariable and multivariable logistic regression analyses were used to determine the impact of the lifestyle factors on the primary outcome measures . MAIN RESULTS AND THE ROLE OF CHANCE Of all 2264 women , 241 women ( 10.6 % ) developed a hypertensive pregnancy complication , 50 women ( 2.2 % ) developed GDM , 79 ( 3.5 % ) children were spontaneously delivered preterm and 155 children ( 6.8 % ) were SGA . All paternal and maternal lifestyle factors were positively correlated . Multivariable analysis showed that paternal lifestyle factors did not have an independent influence on the investigated outcomes . Of the maternal factors , prepregnancy BMI was independently associated with an increased risk of a hypertensive disorder during pregnancy ( odds ratio ( OR ) : 1.12 , 95 % CI 1.09 - 1.16 ) , a higher risk of GDM ( OR BMI > 23 kg/m(2 ) , per BMI unit : 1.13 , 95 % CI 1.08 - 1.18 ) and with a decreased risk of SGA ( OR per BMI point 0.94 , 95 % CI 0.90 - 0.99 ) . Maternal smoking during pregnancy was significantly associated with SGA ( OR 3.00 , 95 % CI 1.80 - 4.99 ) in multivariable analysis . LIMITATIONS , REASONS FOR CAUTION The retrospective nature of the question naire may have induced recall bias . Selection bias might have occurred , as ethnic minorities were less willing to co-operate in the GECKO Drenthe study . The possibility of misclassification bias regarding the primary outcome measures can not be ruled out . Inclusion bias might have occurred as not all question naires of the parents of the children participating in the GECKO Drenthe cohort were completed . WIDER IMPLICATION S OF THE FINDINGS Paternal lifestyle factors do not have an independent effect on the investigated adverse pregnancy outcomes . However , as paternal and maternal lifestyles are positively correlated , both partners should be involved in preconception counselling regarding the investigated outcome measures BACKGROUND Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease . The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown . METHODS Using a polygenic score of DNA sequence polymorphisms , we quantified genetic risk for coronary artery disease in three prospect i ve cohorts - 7814 participants in the Atherosclerosis Risk in Communities ( ARIC ) study , 21,222 in the Women 's Genome Health Study ( WGHS ) , and 22,389 in the Malmö Diet and Cancer Study ( MDCS ) - and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available . We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors : no current smoking , no obesity , regular physical activity , and a healthy diet . RESULTS The relative risk of incident coronary events was 91 % higher among participants at high genetic risk ( top quintile of polygenic scores ) than among those at low genetic risk ( bottom quintile of polygenic scores ) ( hazard ratio , 1.91 ; 95 % confidence interval [ CI ] , 1.75 to 2.09 ) . A favorable lifestyle ( defined as at least three of the four healthy lifestyle factors ) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle ( defined as no or only one healthy lifestyle factor ) , regardless of the genetic risk category . Among participants at high genetic risk , a favorable lifestyle was associated with a 46 % lower relative risk of coronary events than an unfavorable lifestyle ( hazard ratio , 0.54 ; 95 % CI , 0.47 to 0.63 ) . This finding corresponded to a reduction in the st and ardized 10-year incidence of coronary events from 10.7 % for an unfavorable lifestyle to 5.1 % for a favorable lifestyle in ARIC , from 4.6 % to 2.0 % in WGHS , and from 8.2 % to 5.3 % in MDCS . In the BioImage Study , a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category . CONCLUSIONS Across four studies involving 55,685 participants , genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease . Among participants at high genetic risk , a favorable lifestyle was associated with a nearly 50 % lower relative risk of coronary artery disease than was an unfavorable lifestyle . ( Funded by the National Institutes of Health and others . ) PURPOSE The purpose of this study was to investigate the effects of the lifestyle modification coaching program on self efficacy , lifestyle and physiologic indexes related to the recurrence of stroke in patients with stroke . METHODS Sixty-one patients with stroke registered with a stroke center participated in this study . Of the participants , 32 were assigned to the experimental group and 29 to the control group .  Self efficacy , alcohol drinking , smoking , physical activity , BMI ( body mass index ) , WHR ( waist-hip ratio ) , blood lipid level , and blood pressure were measured both for the baseline , as well as after intervention . The lifestyle modification coaching program consisted of an 8-week telecoaching session following face-to-face education . The control group received only the face-to-face education . RESULTS There were significant differences in physical activities , WHR , blood pressure within and between groups after intervention . The lifestyle modification coaching program had significant influences on blood pressure even after gender , age , and physical activity had been adjusted . CONCLUSION The results of the study indicate that lifestyle modification coaching program is effective for physical activity , abdominal obesity and blood pressure . Therefore it can be used by nurses in hospitals and communities as one of the secondary stroke prevention programs for patients with stroke Hypertension is present in 30 % of the adult US population and is a major contributor to cardiovascular disease . The established office-based approach yields only 50 % blood pressure control rates and low levels of patient engagement . Available home technology now provides accurate , reliable data that can be transmitted directly to the electronic medical record . We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients ( matched to age , sex , body mass index , and blood pressure ) in a usual-care group after 90 days . Digital-medicine patients completed question naires online , were asked to su bmi t at least one blood pressure reading/week , and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach . Blood pressure units were commercially available that transmitted data directly to the electronic medical record . Digital-medicine patients averaged 4.2 blood pressure readings per week . At 90 days , 71 % of digital-medicine vs 31 % of usual-care patients had achieved target blood pressure control . Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine , vs 4/2 mm Hg in usual care ( P < .001 ) . Excess sodium consumption decreased from 32 % to 8 % in the digital-medicine group ( P = .004 ) . Mean patient activation increased from 41.9 to 44.1 ( P = .008 ) , and the percentage of patients with low patient activation decreased from 15 % to 6 % ( P = .03 ) in the digital-medicine group . A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change . Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients OBJECTIVES To evaluate the efficacy of a healthcare education program for patients with hypertension . METHODS A multicenter , prospect i ve , cluster-r and omized trial was conducted . R and omization was by primary care center ; 18 of 36 urban primary care centers in Barcelona and its metropolitan area were r and omized to the intervention group ( IG ) and 18 to the control group ( CG ) . The study sample consisted of patients with hypertension ( n=996 ; 515 in the IG and 481 in the CG ) receiving outpatient treatment with antihypertensive drugs . The intervention consisted of personalized information by a trained nurse and written leaflets . Question naires on knowledge and awareness of hypertension and its medication , treatment adherence , healthy lifestyle habits , systolic and diastolic blood pressure , and body mass index were assessed at each visit , with a 12-month follow-up . An intention-to-treat analysis was applied . RESULTS Knowledge of hypertension increased by 27.8 % in the IG and by 18.5 % in the CG , while that of medication increased by 10.1 % in the IG and 5.5 % in the CG . Treatment adherence measured by the Morisky-Green test increased by 9.6 % ( 95 % CI : 5.5 - 13.6 ) in the IG and 8.8 % ( 95 % CI : 4.9 - 12.6 ) in the CG . There were no differences in adherence on the other tests used . No differences were observed between the IG and CG in clinical variables such as blood pressure or BMI at the end of the trial . CONCLUSIONS The educational intervention had no significant impact on patients ' adherence to the medication Background In southern and eastern Mediterranean countries , changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure ( BP ) during adolescence and adulthood . The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors . Methods A cross-sectional study in 2005 , based on a national , stratified , r and om cluster sample of 1294 boys and 1576 girls aged 15 - 19 surveyed in home visits . The socio-economic and behavioral characteristics of the adolescents were recorded . Overweight/obesity were assessed by Body Mass Index ( BMI ) from measured height and weight ( WHO , 2007 ) , abdominal obesity by waist circumference ( WC ) . BP was measured twice during the same visit  . Elevated BP was systolic ( SBP ) or diastolic blood pressure ( DBP ) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15 - 17 y. , and SBP/DBP ≥ 120/80 mm Hg for 18 - 19 y. ; hypertension was SBP/DBP ≥ 95th for 15 - 17 y. and ≥ 140/90 mm Hg for 18 - 19 y. Adjusted associations were assessed by logistic regression . Results The prevalence of elevated BP was 35.1%[32.9 - 37.4 ] : higher among boys ( 46.1 % vs. 33.3 % ; P < 0.0001 ) ; 4.7%[3.8 - 5.9 ] of adolescents had hypertension . Associations adjusted for all covariates showed independent relationships with BMI and WC : - obesity vs. no excess weight increased elevated BP ( boys OR = 2.1[1.0 - 4.2 ] , girls OR = 2.3[1.3 - 3.9 ] ) and hypertension ( boys OR = 3.5[1.4 - 8.9 ] , girls OR = 5.4[2.2 - 13.4 ] ) , - abdominal obesity ( WC ) was also associated with elevated BP in both genders ( for boys : 2nd vs. 1st tertile OR = 1.7[1.3 - 2.3 ] , 3rd vs.1st tertile OR = 2.8[1.9 - 4.2 ] ; for girls : 2nd vs. 1st tertile OR = 1.6[1.2 - 2.1 ] , 3rd vs.1st tertile OR = 2.1[1.5 - 3.0 ] ) but only among boys for hypertension . Associations with other covariates were weaker : for boys , hypertension increased somewhat with sedentary lifestyle , while elevated BP was slightly more prevalent among urban girls and those not attending school . Conclusion Within the limits of BP measurement on one visit only , these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP . Though further assessment is likely needed , the strong association with overweight/obesity observed suggests that interventions aim ed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women . Design Multicentre r and omised trial . We utilised a central telephone r and omisation server , with computer generated schedule , balanced variable blocks , and stratification for parity , body mass index ( BMI ) category , and hospital . Setting Three public maternity hospitals across South Australia . Participants 2212 women with a singleton pregnancy , between 10 + 0 and 20 + 0 weeks ’ gestation , and BMI ≥25 . Interventions 1108 women were r and omised to a comprehensive dietary and lifestyle intervention delivered by research staff ; 1104 were r and omised to st and ard care and received pregnancy care according to local guidelines , which did not include such information . Main outcome measures Incidence of infants born large for gestational age ( birth weight ≥90th centile for gestation and sex ) . Prespecified secondary outcomes included birth weight > 4000 g , hypertension , pre-eclampsia , and gestational diabetes . Analyses used intention to treat principles . Results 2152 women and 2142 liveborn infants were included in the analyses . The risk of the infant being large for gestational age was not significantly different in the two groups ( lifestyle advice 203/1075 ( 19 % ) v st and ard care 224/1067 ( 21 % ) ; adjusted relative risk 0.90 , 95 % confidence interval 0.77 to 1.07 ; P=0.24 ) . Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g ( lifestyle advice 164/1075 ( 15 % ) v st and ard care 201/1067 ( 19 % ) ; 0.82 , 0.68 to 0.99 ; number needed to treat ( NNT ) 28 , 15 to 263 ; P=0.04 ) . There were no differences in maternal pregnancy and birth outcomes between the two treatment groups . Conclusions For women who were overweight or obese , the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes . Trial registration Australian and New Zeal and Clinical Trials Registry ( ACTRN12607000161426 ) Objective This study evaluates the impact of a number of demographic , biological , behavioural and lifestyle health risk factors on the incidence of hypertension in Thail and over a 4-year period . Design A 4-year prospect i ve study of health risk factors and their effects on the incidence of hypertension in a national Thai Cohort Study from 2005 to 2009 . Setting As Thail and is transitioning from a developing to a middle-income developed country , chronic diseases ( particularly cardiovascular disease ) have emerged as major health issues . Hypertension is a major risk factor for heart attack and stroke and cross-sectional studies have indicated that the prevalence is increasing . Study participants A total of 57 558 Sukhothai Thammathirat Open University students who participated in both the 2005 and 2009 question naire surveys and who were normotensive in 2005 were included in the analysis . Measures Adjusted relative risks associating each risk factor and incidence of hypertension by sex , after controlling for confounders such as age , socioeconomic status , body mass index ( BMI ) and underlying diseases . Results The overall 4-year incidence of hypertension was 3.5 % , with the rate in men being remarkably higher than that in women ( 5.2 % vs 2.1 % ) . In both sexes , hypertension was associated with age , higher BMI and comorbidities but not with income and education . In men , hypertension was associated with physical inactivity , smoking , alcohol and fast food intake . In women , hypertension was related to having a partner . Conclusions In both men and women , hypertension was strongly associated with age , obesity and comorbidities while it had no association with socioeconomic factors . The cohort patterns of socioeconomy and hypertension reflect that the health risk transition in Thais is likely to be at the middle stage . Diet and lifestyle factors associate with incidence of hypertension in Thais and may be amenable targets for hypertension control programmes To enhance compliance to physician referral as well as dietary and other lifestyle recommendations given at blood cholesterol ( BC ) screening programs , we r and omized Pawtucket Heart Health Program SCORE ( screening , counseling , referral event ) participants with elevated BC levels into one of four groups :  usual care group ; a participant intervention group ( mailed reminder letter and refrigerator magnet ) ; a physician intervention group ( mailed packet to participant 's physician including letter , National Cholesterol Education Program [ NCEP ] guidelines , and preaddressed postcard to mail to patient ) ; and a group that received both interventions . Beginning four months after the screening , we surveyed study subjects by phone . The participant intervention increased recall of physician referral and dietary recommendations ; however , neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations . Overall , 58 % , 67 % and 34 % of subjects reported complying to physician referral , dietary recommendations , and lifestyle recommendations , respectively . Referral compliance was associated with a longer time interval between screening and survey ( relative risk [ RR ] = 1.3 , 95 % confidence interval [ CI [ = 1.0 , 1.7 ) , possession of medical insurance that covered physician visits ( RR = 2.1 , 95 % CI = 0.98 , 4.4 ) , and history of hypertension ( RR = 2.6 , 95 % CI = 1.1 , 5.8 ) . Dietary compliance was positively associated with baseline BC levels > or = 240 mg/dL ( RR = 3.3 , 95 % CI = 1.4 , 7.3 ) and negatively associated with increasing age ; each one year increase in age corresponded to a 3 % decrease in compliance ( RR = 0.97 , 95 % CI = 0.9 . 1.0 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Cognitive changes are reported infrequently in programs targeting cardiovascular risk . We examined self-efficacy , behavioral barriers and health beliefs in a lifestyle program for drug-treated hypertensives that aim ed to reduce blood pressure , antihypertensive drug needs and cardiovascular risk . In a r and omized controlled trial , we compared usual care ( controls ) and a 4-month program focusing on weight loss , diet and exercise . Outcomes were assessed at baseline , 4 months and 1-year follow-up . Of 241 individuals r and omized , 102/123 in the program and 90/118 of controls completed follow-up . In the program group , dietary barriers fell by 14 % at 4 months ( controls 2 % , P = 0.025 ) and by 8 % at follow-up ( controls 3 % , P = 0.010 ) . Exercise barriers fell by 11 % at 4 months ( controls 3 % , P = 0.020 ) and 17 % ( controls 4 % , P = 0.002 ) at follow-up . Dietary self-efficacy improved by 3 % at 4 months ( controls -1 % , P = 0.003 ) and by 2 % at follow-up ( controls -1 % , P = 0.051 ) . Exercise self-efficacy increased by 8 % at 4 months ( controls 3 % , P < 0.001 ) and by 5 % at follow-up ( controls 3 % , P = 0.130 ) . Changes in cognitive variables predicted changes in health-related behaviors at 4 months and follow-up . A cognitively based lifestyle program in treated hypertensives is associated with improvements in cognitive measures in the shorter and longer term AIM To determine the effect on blood pressure from brisk walking with or without salt restriction in a community based sample of treated hypertensives . METHODS The intervention was undertaken in a community setting with a factorial r and omised controlled trial and blinded assessment of blood pressure . One hundred and eighty one healthy adult volunteers with a sedentary lifestyle and on pharmacological therapy for hypertension  briskly walked for 40 minutes three times per week with or without salt restriction .  Systolic and diastolic blood pressure were assessed at three and six months . RESULTS Of the original 208 participants 181 ( 87 % ) completed the study . significant reductions of up to 7 mm Hg were found in systolic blood pressure at 3 months for brisk walking alone ( p = 0.04 ) and salt restriction alone ( p = 0.03 ) but not for the combined intervention ( p = 0.17 ) . No significant change was found for diastolic blood pressure . There was no significant change in blood pressure at 6 months . CONCLUSIONS Simple advice on exercise and sodium restriction in a community setting can significantly lower systolic blood pressure at least for 3 months . The combination of the two interventions was less effective than each therapy alone The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure ( BP ) control in patients with uncontrolled hypertension . All patients attending the Specialist Hypertension Clinic , University Hospital of the West Indies ( UHWI ) , between January 4 and March 29 , 1999 , with blood pressure > 140/90 mmHg ( n = 80 ) , were r and omly divided into Group 1 , cases ( n = 42 ) and Group 2 , controls ( n = 38 ) . A 40-item pretested question naire , administered at the baseline and final visits of both groups , elicited demographic , lifestyle and knowledge data . Group 1 attended monthly structured interventions for six months . Except for diastolic blood pressure among male controls , diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period ( p < 0.01 ) . Knowledge improved among the male patients ( p < 0.01 ) . Among the female patients , activity scores were significantly increased ( p < 0.01 ) , weight ( p < 0.05 ) and BMI ( p < 0.05 ) were significantly reduced . There were no differences in these variables among the controls . This intervention had a benefit in blood pressure control OBJECTIVES The purpose of this study was to quantify the extent and complexity of residual coronary stenoses following  percutaneous coronary intervention ( PCI )  and to evaluate its impact on adverse ischemic outcomes . BACKGROUND Incomplete revascularization ( IR ) after PCI is common , and most studies have suggested that IR is associated with a worse prognosis compared with complete revascularization ( CR ) . However , formal quantification of the extent and complexity of residual atherosclerosis after PCI has not been performed . METHODS The baseline Synergy Between PCI With Taxus and Cardiac Surgery ( SYNTAX ) score ( bSS ) from 2,686 angiograms from patients with moderate- and high-risk acute coronary syndrome ( ACS ) undergoing PCI enrolled in the prospect i ve ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) trial was determined . The SS after PCI was also assessed , generating the " residual " SS ( rSS ) . Patients with rSS > 0 were defined as having IR and were stratified by rSS tertiles , and their outcomes were compared to the CR group . RESULTS The bSS was 12.8 ± 6.7 , and after PCI the rSS was 5.6 ± 2.2 . Following PCI , 1,084 patients ( 40.4 % ) had rSS = 0 ( CR ) , 523 ( 19.5 % ) had rSS > 0 but ≤2 , 578 ( 21.5 % ) had rSS > 2 but ≤8 , and 501 patients ( 18.7 % ) had rSS > 8 . Age , insulin-treated diabetes , hypertension , smoking , elevated biomarkers or ST-segment deviation , and lower ejection fraction were more frequent in patients with IR compared with CR . The 30-day and 1-year rates of ischemic events were significantly higher in the IR group compared with the CR group , especially those with high rSS . By multivariable analysis , rSS was a strong independent predictor of all ischemic outcomes at 1 year , including all-cause mortality ( hazard ratio : 1.05 , 95 % confidence interval : 1.02 to 1.09 , p = 0.006 ) . CONCLUSIONS The rSS is useful to quantify and risk-stratify the degree and complexity of residual stenosis after PCI . Specifically , rSS > 8.0 after PCI in patients with moderate- and high-risk ACS is associated with a poor 30-day and 1-year prognosis . ( Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes ; NCT00093158 ) Polyphenols in grape and wine have been suggested to contribute to the cardiovascular health benefits of the Mediterranean lifestyle . The reported effects of grape products on blood pressure ( BP ) remain , however , equivocal . In a double-blind placebo controlled crossover study , the effect of two grape extracts on BP and vascular function was assessed in 60 untreated , mildly hypertensive subjects after four weeks intervention . Both extracts ( grape-red wine and grape alone ) had high concentrations of anthocyanins and flavonols , but the grape alone was relatively poor in catechins and procyanidins . Parameters measured included ambulatory and office BP , flow-mediated vasodilation , arterial distensibility , platelet function and plasma lipoproteins . Results showed that 24-hour ambulatory systolic/diastolic BPs were significantly lower in the grape-wine extract intervention ( 135.9 ± 1.3/84.7 ± 0.8 mmHg ; mean ± SEM ) compared to placebo ( 138.9 ± 1.3/86.6 ± 1.2 mmHg ) , predominantly during daytime . Plasma concentrations of the vasoconstrictor endothelin-1 decreased by 10 % , but other measures of vascular function were not affected . Grape juice extract alone had no effect on BP or any measures of vascular function . Polyphenol-rich food products , and may be specifically catechins and procyanidins , may thus help sustain a healthy BP and contribute to the healthy Mediterranean lifestyle Recent studies have indicated a rising prevalence of hypertension in rural and urban areas of India . A population -based survey was carried out during 1994–1995 in seven rural and non-industrialised villages around RaipurRani block in the state of Haryana , India , to determine the prevalence of hypertension and its associated risk factors . A total of 2559 individuals ( 86 % of the eligible population ) in the 16 to 70-year age group were interviewed using a pre-tested structured question naire to find out the lifestyle characteristics . Three blood pressure ( BP ) readings were recorded with a r and om zero sphygmomanometer at three different times . One hundred and fourteen individuals ( 4.5 % ) were found to be hypertensive according to JNC V criteria ( BP of 140/90 mm Hg ) . Mean systolic and diastolic BPs were 116.9 and 71.7 mm Hg in males and 119.1 and 72.7 mm Hg in female subjects respectively ( P < 0.001 ) . females had significantly higher prevalence of hypertension than males ( 5.8 % vs 3.0 % P < 0.05 ) . mean age of hypertensives ( 50.3 ± 13.5 years ) was higher than normotensives ( 34.9 ± 14.5 years , P < 0.001 ) . the prevalence of various risk factors among hypertensives as compared to normotensives were alcohol consumption ( 43.2 % vs 23.1 % , only among males , P < 0.001 ) , higher economic status ( P < 0.001 ) and smoking ( 43 % vs 41.5 % , P > 0.05 ) . In addition hypertensives had higher mean weight ( 53.8 kg vs 48.4 kg , P < 0.001 ) and higher body mass index ( 21.5 vs 18.9 kg/m2 , P < 0.001 ) . analysis showed that advancing age , sedentary lifestyle , higher alcohol consumption and higher body mass index are the risk factors for hypertension in the rural un-industrialised population of india BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms Background Hypertension is one of the most important and well-known risk factors for cardiovascular diseases . Unfortunately , in spite of effective treatments , adherence to the regular use of drugs and other nondrug treatments , such as lifestyle improvement , is often poor . This study evaluates the effectiveness of an educational , supportive intervention – in the form of a Blood Pressure Management Application ( BPMAP ) – on self-management in patients with primary hypertension on controlling the determinant factors of hypertension , and on adherence to treatment . Methods / design A two-arm , parallel- design r and omized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center . One hundred and thirty-two ( 132 ) patients will be r and omly assigned to the intervention and control ( usual method ) groups . The most important inclusion criteria are , having primary hypertension and being pharmacologically treated for it , and not having developed the complications of hypertension , such as myocardial infa rct ion , cerebral stroke and cardiac insufficiency . The participants should be able to read Persian and be able to use the application . The most important outcomes of the study include adherence to treatment , weight control , and regular monitoring of blood pressure which are assessed in the primary assessment ( baseline data question naire ) and again at the 8th and 24th weeks . The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information . Discussion This application has been programmed to reduce many of the nonadherence factors of hypertension treatment . Therefore , the findings may contribute to a rise in adherence to treatment . If proven to have an appropriate impact , it may be extended for use in the national hypertension control plan . Trial registration This study was registered in the Iran R and omized Clinical Trial Center under the number I RCT 2015111712211N2 on 1 January 2016 OBJECTIVE : To assess the effectiveness of mailed hypertension educational material s. DESIGN : Prospect i ve , r and omized , controlled single-blind trial . SETTING : Primary care practice -based research network in which 9 clinics located in Portl and , Oregon participated . PARTICIPANTS : Patients with mildly uncontrolled hypertension as defined as a last blood pressure of 140 to 159/90 to 99 mmHg from query of an electronic medical record data base . INTERVENTIONS : Patients r and omized to intervention were mailed 2 educational packets approximately 3 months apart . The first mailer included a letter from each patient ’s primary care provider . The mailer included a booklet providing an overview of hypertension and lifestyle modification and a refrigerator magnet noting target blood pressure . The second mailing also included a letter from the patient ’s primary care provider , a second educational booklet focused on medication compliance and home blood pressure monitoring , and a blood pressure logbook . The control group consisted of  similar patients receiving usual care for hypertension . MEASUREMENTS AND MAIN RESULTS : Patients from each group were r and omly selected for invitation to participate in a study visit to measure blood pressure and complete a survey ( intervention n=162 ; control n=150 ) . No significant difference was found in mean blood pressure between intervention and control patients ( 135/77 mmHg vs 137/77 mmHg ; P=.229 ) . Patients in the intervention arm scored higher on a hypertension knowledge quiz ( 7.48 ± 1.6 vs 7.06 ± 1.6 ; P=.019 ) , and reported higher satisfaction with several aspects of their care . No significant difference was seen in the prevalence of home blood pressure monitoring ownership or use . CONCLUSIONS : In patients with mildly uncontrolled hypertension , educational mailers did not yield a significant decrease in blood pressure . However , significant improvement in patient knowledge , frequency of home monitoring , and satisfaction with care were demonstrated
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 .