title: Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial.
abstract: OBJECTIVE
  To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Research studies unit.
  
  
  METHODS
  Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group (controls; n = 118) or a lifestyle modification group (programme group; n = 123).
  
  
  METHODS
  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 After 4 months, if mean 24-h ambulatory blood pressure (ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun.
  
  
  METHODS
  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.
authors.affiliation: University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital Unit and West Australian Institute for Medical Research, Perth, Australia. vburke@cyllene.uwa.edu.au
authors.forename: Valerie
authors.initials: V
authors.lastname: Burke
authors.forename: Lawrie J
authors.initials: LJ
authors.lastname: Beilin
authors.forename: Hayley E
authors.initials: HE
authors.lastname: Cutt
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mansour
authors.forename: Amy
authors.initials: A
authors.lastname: Wilson
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Mori
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D003131:Combined Modality Therapy; D004039:Diet, Sodium-Restricted; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents