Effect of drug and diet treatment of mild hypertension on diastolic blood pressure. The TAIM Research Group.
The Trial of Antihypertensive Interventions and Management is a multicenter randomized trial designed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension (diastolic blood pressure 90-100 mm Hg). Eight hundred and seventy-eight participants at 110-160% of ideal weight were randomly allocated to nine drug/diet treatment groups receiving either a placebo, chlorthalidone (25 mg), or atenolol (50 mg), combined with a usual, a weight loss, or a low sodium/high potassium diet. The primary outcome was diastolic blood pressure change from baseline to 6 months. Seven hundred and eighty-seven participants had follow-up data. The mean baseline diastolic blood pressure was 93.8 mm Hg; 55.9% of the participants were male, and the weight loss diet group lost an average of 4.7 kg. Multiple comparisons were accounted for in the analysis. A significantly greater lowering of diastolic blood pressure (12.4 mm Hg) was achieved in the atenolol group compared with either the low sodium/high potassium diet group (7.9 mm Hg, p = 0.001) or weight loss group (8.8 mm Hg, p = 0.006). Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering (15.1 mm Hg) when compared with the diuretic alone (10.8 mm Hg, p = 0.002), but adding a low sodium/high potassium diet (12.2 mm Hg, p = 0.029) did not. In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration, drugs outperform diet, and weight loss is beneficial, especially with diuretics.
Langford
H G
HG
Department of Medicine, University of Mississippi Medical Center, Jackson.
Davis
B R
BR
Blaufox
D
D
Oberman
A
A
Wassertheil-Smoller
S
S
Hawkins
M
M
Zimbaldi
N
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D001835:Body Weight; D003971:Diastole; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009318:Natriuresis; D011188:Potassium / Q000652:urine; D012044:Regression Analysis
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D011188:Potassium