Effects of Comprehensive Lifestyle Modification on Blood Pressure Control: Main Results of the PREMIER Clinical Trial
Abstract
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: Randomized 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 randomized 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.
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In the PREMIER trial, only 28% of participants met sodium targets (eg, <1500 mg/d) at 6 months, although it was relatively feasible to meet the target of <2300 mg/d by avoiding processed foods.
“Notably, in the PREMIER trial (PREMIER: Lifestyle Interventions for Blood Pressure Control), only 28% of participants met sodium targets (eg, <1500 mg/d) at 6 months, although it was relatively feasible to meet the target of <2300 mg/d by avoiding processed foods.14,70”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [70]
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- Authors
- Writing Group of the PREMIER Collaborative Research Group
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Writing Group of the PREMIER Collaborative Research Group
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-04-23
- Volume
- 289
- Issue
- 16
- Pages
- 2083-93
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2221567553
- Cited by
- 1,331
- References
- 28
- Citations by year
- 2026: 15 · 2025: 23 · 2024: 31 · 2023: 29 · 2022: 29 · 2021: 53 · 2020: 56 · 2019: 68 · 2018: 46 · 2017: 42 · 2016: 68 · 2015: 57 · 2014: 81 · 2013: 82 · 2012: 78
- FWCI
- 42.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (UO1 HL60574, U01HL060571, U01HL060570, UO1 HL60570, U01HL060574, U01HL062828, UO1 HL60573, U01HL060573, UO1 HL62828, UO1 HL60571)
- National Center for Research Resources (M01RR000052)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- hypertension, blood pressure control, lifestyle modification, DASH diet, weight loss, sodium reduction, physical activity, alcohol consumption, behavioral interventions, stage 1 hypertension, hypertension prevalence, fruit and vegetable intake, dietary intervention, African American adults, older adults, fitness improvement, cardiovascular risk reduction, cost-effectiveness, quality of life
- MeSH terms
- Adult, Alcohol Drinking, Blood Pressure, Cardiovascular Diseases, Diet, Diet, Sodium-Restricted, Female, Humans, Hypertension, Life Style, Male, Middle Aged, Patient Education as Topic, Risk Factors, Weight Loss, Health Behavior, Exercise
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