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Objective: To assess effects of multifactorial lifestyle modifi-cation on antihypertensive drug needs in treated hypertensive individuals. Design: Randomized controlled trial. Setting:Research studies unit. Participants: 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). Intervention: 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 After 4 months, if mean 24-h ambulatory blood pressure(ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Main outcome measures: 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.
Objective: To assess effects of multifactorial lifestyle modifi cation on antihypertensive drug needs in treated hypertensive individuals. Design: Randomized controlled trial. Setting: Research studies unit. Participants: Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, n = 123). Intervention: A 4-month program 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 Main outcome measures: Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Results: Ninety control group and 102 program gr 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 program (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 program group; P = 0.73) At follow-up, sex-related differences were not significant (P = 0.038) in men (control 44%; program 66%) but not in women , and 41% in the control group and 43% in the program group maintained drug-withdrawal status. With the program, net weight loss was 3.3 kg (P <0.001) at 4 months and 3.0 kg (P <0.001) Conclusions: A 4-month multifactorial lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreas (P <0.001) and 3.5 cm ed central obesity persisted 1 year later and could reduce overall cardiovascular risk.