title: Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To quantify effectiveness of lifestyle interventions for hypertension.
  
  
  METHODS
  Electronic bibliographic databases from 1998 onwards, existing guidelines, systematic reviews.
  
  
  METHODS
  We included randomized, controlled trials with at least 8 weeks' follow-up, comparing lifestyle with control interventions, enrolling adults with blood pressure at least 140/85 mmHg. Primary outcome measures were systolic and diastolic blood pressure. Two independent reviewers selected trials and abstracted data; differences were resolved by discussion.
  
  
  RESULTS
  We categorized trials by type of intervention and used random effects meta-analysis to combine mean differences between endpoint blood pressure in treatment and control groups in 105 trials randomizing 6805 participants. 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.
  
  
  CONCLUSIONS
  Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.
authors.affiliation: University of Newcastle upon Tyne, Centre for Health Services Research, Newcastle upon Tyne, UK.
authors.forename: Heather O
authors.initials: HO
authors.lastname: Dickinson
authors.forename: James M
authors.initials: JM
authors.lastname: Mason
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Nicolson
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: Fiona R
authors.initials: FR
authors.lastname: Beyer
authors.forename: Julia V
authors.initials: JV
authors.lastname: Cook
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
mesh_terms: D000288:Administrative Personnel; D001794:Blood Pressure; D002136:Calcium, Dietary / Q000008:administration & dosage; D004032:Diet; D015444:Exercise; D005395:Fish Oils / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008019:Life Style; D008274:Magnesium / Q000008:administration & dosage; D011188:Potassium / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic
chemical_list: D002136:Calcium, Dietary; D005395:Fish Oils; D008274:Magnesium; D011188:Potassium