Comprehensive lifestyle modification and blood pressure control: a review of the PREMIER trial.

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 randomized 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.

A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial.

This study presents an extensive analysis of the effects on blood pressure (BP) of changes in sodium intake over a wide array of subgroups, including joint subgroups defined by age and hypertension status, race or ethnicity and hypertension status, and gender and race or ethnicity. Participants were given 3 levels of sodium (50, 100, and 150 mmol/2,100 kcal) for 30 days while consuming the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables, and low-fat dairy) or a more typical American diet. Within each diet and subgroup, there was a general pattern such that the lower the sodium level, the greater the mean reduction in BP.

A trial of omega-3 fatty acids for prevention of hypertension.

Although omega-3 polyunsaturated fatty acid supplements reduce blood pressure (BP), the typical doses cause untoward side effects. A novel fatty acid supplement was tested in a randomized trial of patients with high normal diastolic BP. The novel fatty acid supplement did not significantly reduce BP in patients with high normal diastolic blood pressure.

Effect of dietary sodium intake on blood lipids: results from the DASH-sodium trial.

We evaluated the effect on serum lipids of sodium intake in 2 diets. Participants were randomly assigned to a typical American control diet or the Dietary Approaches to Stop Hypertension (DASH) diet, each prepared with 3 levels of sodium (targeted at 50, 100, and 150 mmol/d per 2100 kcal). The DASH diet is increased in fruits, vegetables, and low-fat dairy products and is reduced in saturated and total fat.

Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality.

Background: The relative importance of blood pressure components (systolic blood pressure, diastolic blood pressure, and pulse pressure) on cardiovascular risk is currently being debated. Many studies, however, are limited by inadequate statistical methods to separate these effects.

Objective: To evaluate the joint effect of blood pressure components on all-cause and cardiovascular mortality by using nonparametric and change point models.

Supplementation of diets with alpha-tocopherol reduces serum concentrations of gamma- and delta-tocopherol in humans.

Despite promising evidence from in vitro experiments and observational studies, supplementation of diets with alpha-tocopherol has not reduced the risk of cardiovascular disease and cancer in most large-scale clinical trials. One plausible explanation is that the potential health benefits of alpha-tocopherol supplements are offset by deleterious changes in the bioavailability and/or bioactivity of other nutrients. We studied the effects of supplementing diets with RRR-alpha-tocopheryl acetate (400 IU/d) on serum concentrations of gamma- and delta-tocopherol in a randomized, placebo-controlled trial in 184 adult nonsmokers.

The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults.

Dietary strategies to prevent and treat osteoporosis focus on increased intake of calcium and vitamin D. Modification of whole dietary patterns and sodium reduction may also be effective. We examined the effects of two dietary patterns and three sodium levels on bone and calcium metabolism in a randomized feeding study.

The potential impact of nonpharmacologic population-wide blood pressure reduction on coronary heart disease events: pronounced benefits in African-Americans and hypertensives.

Background: Previous estimates of the population-wide impact of nonpharmacologic interventions that lower blood pressure (BP) have typically assumed a uniform response to the intervention. However, several nonpharmacologic interventions reduce BP to a greater degree in hypertensives and African-Americans.

Methods: We used the Framingham risk equation and data from the Third National Health and Nutrition Examination Survey (NHANES III) to estimate the number of coronary heart disease (CHD) events that would be prevented in the United States assuming a population-wide adoption of the DASH (Dietary Approaches to Stop Hypertension) diet under three scenarios: (1) an overall uniform systolic blood pressure (SBP) shift, (2) race-specific uniform SBP shifts, and (3) race-specific progressive SBP shifts.

Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial.

Although group characteristics are known to influence average blood pressure response to changes in salt intake, predictability of individual responses is less clear. We examined variability and consistency of individual systolic blood pressure responses to changes in salt intake in 188 participants who ate the same diet at higher, medium, and lower (140, 104, 62 mmol/d) sodium levels for 30 days each, in random order, after 2 weeks of run-in at the higher sodium level. Regarding variability in systolic blood pressure changes over time, changes from run-in to higher sodium (no sodium level change) ranged from -24 to +25 mm Hg; 8.

Leukocytosis, hypoalbuminemia, and the risk for chronic kidney disease in US adults.

Background: Atherosclerosis and chronic kidney disease (CKD) share several common antecedents. However, the association between inflammatory markers and incident CKD is unknown.

Methods: We determined risk for incident CKD, defined by treatment for kidney failure or death related to kidney disease, in 9,250 US adults aged 30 to 74 years who participated in the Second National Health and Nutrition Examination Survey (NHANES II), a nationally representative prospective cohort study with 17 years of follow-up.

Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics.

Purpose: To describe PREMIER, a randomized 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 randomized 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 standard of care group. The two BLS interventions consist of group and individual counseling sessions for 18 months.

Inflammation modifies the effects of a reduced-fat low-cholesterol diet on lipids: results from the DASH-sodium trial.

Background: Inflammatory mediators regulate key aspects of lipid metabolism. We hypothesized that inflammation could diminish the cholesterol-lowering effect of a reduced-fat/low-cholesterol diet.

Methods And Results: After a 2-week run-in period on a control diet (37% total fat, 16% saturated fat), 100 participants were randomized to the control or DASH diet (27% total fat, 6% saturated fat) for 12 weeks.

The rationale and design of the AASK cohort study.

Hypertensive kidney disease commonly progresses. The primary objective of the AASK (African American Study of Kidney Disease and Hypertension) Cohort Study is to determine prospectively the course of kidney function and risk factors for kidney disease progression in African Americans with hypertensive kidney disease who receive recommended anti-hypertensive therapy. The AASK Cohort Study is a prospective, observational study that is an extension of the AASK trial.

The Chronic Renal Insufficiency Cohort (CRIC) Study: Design and Methods.

Insights into end-stage renal disease have emerged from many investigations but less is known about the epidemiology of chronic renal insufficiency (CRI) and its relationship to cardiovascular disease (CVD). The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for progression of CRI and CVD among CRI patients and develop models to identify high-risk subgroups, informing future treatment trials, and increasing application of preventive therapies. CRIC will enroll approximately 3000 individuals at seven sites and follow participants for up to 5 yr.

Lifestyle modification as a means to prevent and treat high blood pressure.

High BP is one of the most important and common risk factors for atherosclerotic cardiovascular disease and renal disease. The contemporary approach to the epidemic of elevated BP and its complications involves pharmacologic treatment of hypertensive individuals and "lifestyle modification," which is beneficial for both nonhypertensive and hypertensive persons. A substantial body of evidence strongly supports the concept that lifestyle modification can have powerful effects on BP.

The DASH diet enhances the blood pressure response to losartan in hypertensive patients.

Background: The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, and low fat dairy products, significantly lowers blood pressure (BP). We conducted a clinical trial to assess the BP response to the DASH diet with an antihypertensive medication, losartan, in participants with essential hypertension.

Methods: A total of 55 hypertensive participants were randomly assigned to 8 weeks of controlled feeding with either a control diet or the DASH diet.

Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial.

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.