Long-term Diet and Lifestyle Changes for Control of Mild Hypertension: The Treatmement of Mild Hypertension Stud (TOMHS)

Abstract

There is considerable interest in the feasibility of incorporating nutritional and lifestyle changes into blood pressure treatment and cardiovascular disease risk reduction programs in clinical practice settings. TOMHS was a multi-center, randomized trial comparing a non-drug lifestyle intervention plus placebo with 5 groups receiving the lifestyle intervention plus one of five active antihypertensive drugs. Participants were 902 men and women, age 45–69, with mild hypertension (DPB 90–99mmHg.) All patients received diet and lifestyle intervention provided by registered dietitians through a series of group and individual sessions. The program included an initial 6 month intensive education program followed by at least quarterly individual assessment and counseling sessions with the dietitians. The goals were: weight loss ≥ 10lbs.; 25% reduction in dietary sodium; 150minutes/week of moderate physical activity (600kcal); <2 alcoholic drinks/day. After one year, significant lifestyle changes were achieved and a large % of the changes were maintained for 4 years. At 2 years 81% of the initial weight loss was maintained and at 4 years, 50%. At one year, patients had increased their leisure time physical activity (PA) by 82% (430kcal/wk) and after 4 years nearly 1/2 of this increase in physical activity was maintained. Walking, fast walking, bicycling, and calisthenics were die most common activities. Walking accounted for 60% of the total increase in PA. Greater ↑ in PA were associated with greater weight loss. After adjustment for weight loss ↑ PA was also associated with greater ↑ in HDL and ↓ in TG in men only.LIFE STYLE CHANGES AT 1,2,3, AND 4 YEARS1 Year2 Years3 Years4 YearsWt. Loss(Lbs.)−10.5−8.5−7.4−5.9Urine Na(% chg)−23.0−20.0−16.0−9.0Alcohol(% chg)−29.0−29.9−29.0−31.0Activity(% chg)+83.0+75.0+64.0+46.0N =848838815803In the patients receiving the lifestyle intervention alone (placebo group), SBP fell by 10.4 mmHg and DBP by 9.4 mmHg and DBP was controlled (<95mmHg) without medications in 59% of this group over 4 years. Serum lipids also improved; the magnitude of change was related to amount of wt. loss. These data show major lifestyle changes can be achieved and maintained in mildly hypertensive patients through systematic dietitian-delivered lifestyle intervention programs. Program components and project evaluation information will be presented.