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Blood Pressure Study Yields Cholesterol-Lowering Bonus

Lisa Esposito

New research indicates that efforts to reduce high blood pressure lead to additional benefits—lower cholesterol and cardiovascular risks. This bonus effect adds up to extra reduction in heart disease and stroke risk, according to investigators involved in the PREMIER clinical trial, a study of blood pressure control sponsored by the National Heart, Lung, and Blood Institute (NHLBI).

In 2003, the PREMIER clinical trial showed that combining lifestyle changes and the Dietary Approaches to Stop Hypertension (DASH) diet lowered blood pressure.¹

At the American Heart Association Scientific Sessions in Orlando, Fla., in November 2004, more good news emerged from PREMIER: Patients educated and counseled on making lifestyle changes—with or without the DASH diet—lowered their blood cholesterol as well as blood pressure.

"As PREMIER was primarily a study of people with high blood pressure, not high lipids, the results are substantially more impressive," says NHLBI researcher Lawton Cooper, MD, PhD.

PREMIER randomized a total of 810 adults, at four study sites, to one of three groups: 1) established lifestyle changes (EST) alone; 2) EST plus DASH diet (EST+DASH); or 3) an "Advice-Only" control group.

The term EST was used to encompass the lifestyle changes that physicians often recommend to patients: weight loss, decreased dietary sodium, decreased alcohol consumption, and increased physical activity.

At 6 months, blood levels of total cholesterol, LDL cholesterol, total cholesterol–HDL ratio, and triglycerides were lowered more in the lifestyle recommendations and lifestyle-plus-DASH groups than in the control group.

The second study component, the DASH Eating Plan, is a diet high in fruits, vegetables, and low-fat dairy products and low in saturated and total fat. It encourages intake of whole-grain products, fish, poultry, and nuts.

Unlike the earlier-released results, in which lifestyle changes combined with the DASH diet had an even greater effect on hypertension than lifestyle changes alone, in regards to cholesterol "DASH did not make an overwhelming change in results; there was no additional benefit from DASH," Cooper says.

"We don't want people to come out of this [with the idea that] DASH doesn't add value," Cooper tells DOC News. "People who can't lose weight or increase activity can still benefit by increasing fruits and vegetables and decreasing fats and sodium intake."

BETTER THAN BASELINE

Of the participants, 62% were female, 34% were African American, and 95% were overweight or obese. All had blood pressure greater than 120/80 mmHg (but were not on antihypertensive medication). The mean age was 50 years.

People with diabetes (fasting blood glucose 126 mg/dl) and prior cardiovascular disease were excluded. People identified as having prediabetes were included. Serum LDL cholesterol was at or above 130 mg/dl in 54% of the subjects.

The EST and EST+DASH subjects received 18 group and individual counseling sessions over 6 months, whereas the Advice-Only group had two 30-minute education sessions with a research team member and were given written materials on lifestyle changes to reduce hypertension risk.

The 6-month results showed a marked improvement over baseline for the intervention groups, but only mild improvement for the Advice-Only group.

• Weight loss: Advice-Only group members lost an average 2.4 pounds, EST members lost 10.8 pounds, and EST+ DASH members lost 12.8 pounds.
  
• Fat intake: The Advice-Only group reduced total fat intake (by 1%) and saturated fat intake (by 0.4%) a little; the EST group reduced intake about four times as much (3.9% total fat, 1.5% saturated) as Advice-Only; and EST+DASH reduced intake (9.5% total fat, 3.3% saturated) more than twice as much as EST.
  
• Total and LDL cholesterol: Blood levels of total cholesterol (5.5 mg/dl reduction) and LDL cholesterol (8.8 mg/dl reduction) went down in the Advice-Only group, but dropped significantly more in both the EST (total cholesterol 12.5 mg/dl, LDL 18.5 mg/dl reduction) and EST+DASH groups (total fat 11.2 mg/dl, LDL 19.9 mg/dl reduction).
  
• HDL cholesterol: The interventions did not cause HDL cholesterol to drop, which has been an undesirable effect in other studies.
  
• Total cholesterol–HDL ratio and triglycerides: Total cholesterol–HDL ratio dropped moderately for the Advice-Only group, more for the intervention groups. Triglyceride levels dropped as well, which has not always occurred in lifestyle studies.
  

A CLOSER LOOK AT LIPIDS

Improvements in lipid profile were even stronger for individuals who started the study with higher LDL cholesterol levels (130 mg/dl). If the same study had specifically targeted people with higher LDL levels, the results would have been even more striking, Cooper suggests.

The researchers' conclusion, "Persons adopting [lifestyle changes] designed to lower blood pressure lowered their risk of heart disease and stroke even more than expected because of a reduction in blood lipid levels," gives health care providers added reason to recommend lifestyle changes to their patients. Further, for those patients who are unable to make some lifestyle modifications, the DASH diet may provide a method of risk reduction that they can use.

These new results are being written up for future publication; an 18-month follow-up phase will complete the study.

Main Conclusions

• Education and counseling for lifestyle changes to lower blood pressure resulted in weight loss and increased physical fitness, which also improved blood lipids with no increase in triglycerides.
  
• The DASH diet, which calls for a lower fat intake, does not further improve blood lipids—but it remains important for lowering blood pressure and lipids in persons who do not lose weight or increase physical activity.
  

References

1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, et al.: Effects of comprehensive lifestyle modification on blood pressure control: main results of the Premier Clinical Trial. JAMA 289:2083–2093, 2003.[Abstract/Free Full Text]

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Esposito, L. Search for Related Content PubMed Articles by Esposito, L. Social Bookmarking                What's this?