Effect of Comprehensive Therapeutic Lifestyle Changes on Prehypertension

Emory University School of Medicine, Atlanta, Georgia, USA.
The American journal of cardiology (Impact Factor: 3.28). 01/2009; 102(12):1677-80. DOI: 10.1016/j.amjcard.2008.08.034
Source: PubMed


Although national clinical guidelines promulgate therapeutic lifestyle changes (TLC) as a cornerstone in the management of prehypertension, there is a perceived ineffectiveness of TLC in the real world. In this study of 2,478 ethnically diverse (African Americans n = 448, Caucasians n = 1,881) men (n = 666) and women (n = 1,812) with prehypertension and no known atherosclerotic cardiovascular disease, diabetes mellitus, or chronic kidney disease, we evaluated the clinical effectiveness of TLC in normalizing blood pressure (BP) without antihypertensive medications. Subjects were evaluated at baseline and after an average of 6 months of participation in a community-based program of TLC. TLC included exercise training, nutrition, weight management, stress management, and smoking cessation interventions. Baseline BP (125 +/- 8/79 +/- 3 mm Hg) decreased by 6 +/- 12/3 +/- 3 mm Hg (p <or=0.001), with 952 subjects (38.4%) normalizing their BP (p <or=0.001). In subjects with a baseline systolic BP of 120 to 139 mm Hg (n = 2,082), systolic BP decreased by 7 +/- 12 mm Hg (p <or=0.001). In subjects with a baseline diastolic BP of 80 to 89 mm Hg (n = 1,504), diastolic BP decreased by 6 +/- 3 mm Hg (p <or=0.001). There were no racial differences in the magnitude of reduction in BP; however, women had greater BP reductions than men (p <or=0.001). Also, subjects with a baseline body mass index (BMI) <30 kg/m(2) had a greater reduction in BP than those with a BMI >or=30 kg/m(2). In conclusion, the present study adds to previous research by reporting on the effectiveness, rather than the efficacy, of TLC when administered in a real-world, community-based setting.

6 Reads
  • Source
    • "As a result, it is important to identify the per-patient and total expenditure associated with prevalent conditions such as CKD, with the aim of developing targeted, cost-effective therapeutic interventions that prevent the development and progression of these diseases. The financial expenditure associated with many of Australia's most prevalent and costly diseases can be reduced by adopting cost-effective lifestyle modifications [4] [5]. Australia's decreasing rate of physical activity is associated with increasing rates of obesity [5] [6], a risk factor that is strongly related to the development and progression of CKD [5] [7] [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set at P < 0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia's healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted.
    International Journal of Nephrology 04/2014; 2014(9):120537. DOI:10.1155/2014/120537
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical trials have shown that weight reduction with lifestyles can delay or prevent diabetes and reduce blood pressure. An appropriate definition of obesity using anthropometric measures is useful in predicting diabetes and hypertension at the population level. However, there is debate on which of the measures of obesity is best or most strongly associated with diabetes and hypertension and on what are the optimal cut-off values for body mass index (BMI) and waist circumference (WC) in this regard. The aims of the study were 1) to compare the strength of the association for undiagnosed or newly diagnosed diabetes (or hypertension) with anthropometric measures of obesity in people of Asian origin, 2) to detect ethnic differences in the association of undiagnosed diabetes with obesity, 3) to identify ethnic- and sex-specific change point values of BMI and WC for changes in the prevalence of diabetes and 4) to evaluate the ethnic-specific WC cutoff values proposed by the International Diabetes Federation (IDF) in 2005 for central obesity. The study population comprised 28 435 men and 35 198 women, ≥ 25 years of age, from 39 cohorts participating in the DECODA and DECODE studies, including 5 Asian Indian (n = 13 537), 3 Mauritian Indian (n = 4505) and Mauritian Creole (n = 1075), 8 Chinese (n =10 801), 1 Filipino (n = 3841), 7 Japanese (n = 7934), 1 Mongolian (n = 1991), and 14 European (n = 20 979) studies. The prevalence of diabetes, hypertension and central obesity was estimated, using descriptive statistics, and the differences were determined with the χ2 test. The odds ratios (ORs) or  coefficients (from the logistic model) and hazard ratios (HRs, from the Cox model to interval censored data) for BMI, WC, waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) were estimated for diabetes and hypertension. The differences between BMI and WC, WHR or WSR were compared, applying paired homogeneity tests (Wald statistics with 1 df). Hierarchical three-level Bayesian change point analysis, adjusting for age, was applied to identify the most likely cut-off/change point values for BMI and WC in association with previously undiagnosed diabetes. The ORs for diabetes in men (women) with BMI, WC, WHR and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50) and 1.62 (1.70), respectively and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28) and 1.63 (1.50). For diabetes the OR for BMI did not differ from that for WC or WHR, but was lower than that for WSR (p = 0.001) in men while in women the ORs were higher for WC and WSR than for BMI (both p < 0.05). Hypertension was more strongly associated with BMI than with WHR in men (p < 0.001) and most strongly with BMI than with WHR (p < 0.001), WSR (p < 0.01) and WC (p < 0.05) in women. The HRs for incidence of diabetes and hypertension did not differ between BMI and the other three central obesity measures in Mauritian Indians and Mauritian Creoles during follow-ups of 5, 6 and 11 years. The prevalence of diabetes was highest in Asian Indians, lowest in Europeans and intermediate in others, given the same BMI or WC category. The  coefficients for diabetes in BMI (kg/m2) were (men/women): 0.34/0.28, 0.41/0.43, 0.42/0.61, 0.36/0.59 and 0.33/0.49 for Asian Indian, Chinese, Japanese, Mauritian Indian and European (overall homogeneity test: p > 0.05 in men and p < 0.001 in women). Similar results were obtained in WC (cm). Asian Indian women had lower  coefficients than women of other ethnicities. The change points for BMI were 29.5, 25.6, 24.0, 24.0 and 21.5 in men and 29.4, 25.2, 24.9, 25.3 and 22.5 (kg/m2) in women of European, Chinese, Mauritian Indian, Japanese, and Asian Indian descent. The change points for WC were 100, 85, 79 and 82 cm in men and 91, 82, 82 and 76 cm in women of European, Chinese, Mauritian Indian, and Asian Indian. The prevalence of central obesity using the 2005 IDF definition was higher in Japanese men but lower in Japanese women than in their Asian counterparts. The prevalence of central obesity was 52 times higher in Japanese men but 0.8 times lower in Japanese women compared to the National Cholesterol Education Programme definition. The findings suggest that both BMI and WC predicted diabetes and hypertension equally well in all ethnic groups. At the same BMI or WC level, the prevalence of diabetes was highest in Asian Indians, lowest in Europeans and intermediate in others. Ethnic- and sex-specific change points of BMI and WC should be considered in setting diagnostic criteria for obesity to detect undiagnosed or newly diagnosed diabetes. Epidemiologiset ja kliiniset tutkimukset ovat osoittaneet, että tyypin 2 diabeteksen kehittymistä voidaan ehkäistä ja korkeaa verenpainetta voidaan laskea terveellisen elintapaohjauksen avulla henkilöillä, joilla on korkea riski tyypin 2 diabetekseen. Tarkoituksenmukainen lihavuuden määritelmä pohjautuen antropometrisiin mittauksiin on hyödyllinen väestötason tutkimuksissa. Kuitenkaan ei ole yksimielistä näkemystä siitä, onko kehon painoindeksi vai vyötärön ympärysmitta parempi ennustamaan tyypin 2 diabetesta ja verenpainetautia. Ei ole myöskään selvillä, mitkä ovat painoindeksin ja vyötärönympäryksen optimaaliset raja-arvot, joita tulisi tässä yhteydessä soveltaa aasialaisissa ja eurooppalaisissa väestöissä. Tämän väitöskirjatyön tavoitteina oli 1) verrata painoindeksin ja vyötärön ympärysmitan yhteyden voimakkuutta aikaisemmin toteamattomassa tai vastatodetussa diabeteksessa (ja verenpainetaudissa) aasialaista alkuperää olevilla henkilöillä; 2) todeta etnisien ryhmien välisiä eroja edellä mainituissa yhteyksissä; 3) identifioida ikä- ja sukupuolikohtaiset painoindeksin ja vyötärön ympärysmitan raja-arvot ennustamaan diabeteksen vallitsevuuden muutosta eri etnisessa ryhmissä 4) Arvioida vyötärön ympärysmitan raja-arvoja, jotka International Diabetes Federation (IDF) on vuonna 2005 ehdottanut eri etnisille ryhmille tarkoittamaan keskivartalolihavuutta. Tutkimuksen aineisto koostuu 39 aasialaisesta ja eurooppalaisesta kohortista DECODA ( ) ja DECODE ( ) tutkimuksissa, joihin osallistui yhteensä 28 435 miestä ja 35 198 naista, iältään yli 25 vuotiaita. Näistä kohorteista, 5 oli Intiasta (n =13 537), 3 Mauritukselta (n= 4505 alkuperältään intialaisia ja n= 1075 kreolejaa), 8 Kiinasta (n=10 801), yksi Filippiineiltä (n= 3841), 7 Japanista (n= 7934), yksi Mongoliasta (n= 1991), ja 14 Eurooppasta (n= 20 979). Tyypin 2 diabeteksen, verenpainetaudin, ja vyötärölihavuuksen prevalenssit laskettiin. Antropometristen muuttujien ja eri etnisten ryhmien välisiä eroja testattiin käyttäen useita tilastomenetelmiä kuten χ2 testi, Waldin testi, logistinen regressioanalyysi ja Coxin regressioanalyysi. Vedonlyöntisuhdetta (Odds ratio, OR), -kertoimia logistisesta mallista ja vaarasuhteita (Hazards ratio, HR) Coxin mallista sovellettiin analyyseissä, joissa tutkittiin painoindeksin, vyötärön ympärysmitan, vyötärö-lantio suhteen ja vyötärö-pituus suhteen yhteyttä diabetekseen ja verenpainetautiin. Näiden antropometristen muuttujien välisiä eroja kyseisissä analyyseissä arvioitiin parittaisilla homogeenisyystesteillä (Waldin testi, 1 vapausaste). Hierarkkista kolmen tason Bayesilaista ikävakioitua muutoskohta-analyysiä sovellettiin etsittäessä todennäköisintä muutoskohtaa painoindeksille ja vyötärön ympärysmitalle toteamaan aikaisemmin diagnosoimaton diabetes. OR:t painoindeksille, vyötärön ympärysmitalle, vyötärö-lantio suhteelle ja vyötärö-pituus suhteelle diabeteksen suhteen olivat miehillä (naisilla) 1.52 (1.59), 1.54 (1.70), 1.53 (1.50) ja 1.62 (1.70). Vastaavat OR:t verenpainetaudin suhteen olivat 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). OR painoindeksille ei eronnut OR:sta vyötärön ympärysmitalle tai vyötärö-lantio suhteelle, mutta oli pienempi kuin OR vyötärö-pituus suhteelle (p=0.001) miehillä, kun taas naisilla OR vyötärön ympärysmitalle tai vyötärö-pituus suhteelle olivat suuremmat kuin painoindeksille (molemmat p<0.05). Painoindeksin yhteys verenpainetautiin oli voimakkaampi kuin vyötärö-lantio suhteen miehillä (p<0.001), ja naisilla painoindeksin yhteys oli voimakkaampi kuin vyötärön ympärysmitan (p<0.05), vyötärö-lantio suhteen (p<0.001) ja vyötärö-pituus suhteen (p<0.001). HR:t diabeteeksen ja verenpainetaudin esiintyvyydelle eivät eronneet painoindeksin ja kolmen muun antropometrisen muuttujan välillä mauritiuslaisilla intialaisilla ja kreoleilla. Tyypin 2 diabeteksen prevalenssi oli korkein intialaisilla, matalin eurooppalaisilla, ja keskitasolla muissa Aasialaisissa väestöissä. Logistisen regressiomallin arviodut painoindeksin (kg/m2) - kerroimet diabetekselle olivat (mies/nainen): 0.34/0.28, 0.41/0.43, 0.42/0.61, 0.36/0.59, and 0.33/0.49 intialaisilla, kiinalaisilla, japanilaisilla, mauritiuslaisilla intilaisilla ja eurooppalaisilla (kokonais-homogeenisuustesti: p > 0.05 miehillä ja p < 0.001 naisilla). Intialaisilla naisilla oli pienempi -kerroin kun muilla naisilla. Painoindeksin muutoskohdaksi diabetesriskin suhteen todettiin 29.5, 25.6, 24.0, 24.0, ja 21.5 kg/m2miehillä ja 29.4, 25.2, 24.9, 25.3, ja 22.5 naisilla kg/m2 eurooppalaisilla, kiinalaisilla, mauritiuslaisilla intialaisilla, japanilaisilla ja intialaisilla. Vyötärön ympärysmitan muutoskohdaksi diabetesriskin suhteen todettiin 100, 85, 79 ja 82 cm miehillä ja 91, 82, 82 ja 76 cm naisilla eurooppalaisilla, kiinalaisilla, mauritiuslaisilla intialaisilla ja intialaisilla. Sovellettaessa IDF:n 2005 ehdottamia vyötärön ympärysmitan raja-arvoja keskivartalolihavuudelle, sen vallitsevuus oli japanilaisilla miehillä korkeampi kuin muissa aasialaisissa väestöissä. Verrattuna Yhdysvaltojen National Cholesterol Education Program:n käyttämiin raja-arvoihin keskivartalolihavuuden vallitsevuus oli IDF:n raja-arvoja käytettäessä 52 kertaa korkeampi japanilaisilla miehillä, mutta 0.8 kertaa matalampi japanilaisilla naisilla. Nämä löydökset osoittavat sekä painoindeksin että vyötärön ympärysmitan ennustavan diabeteksen ja verenpainetaudin esiintyvyyttä yhdenmukaisesti kaikissa etnisissä ryhmissä. Samalla painoindeksin ja vyötärön ympärysmitan tasolla diabeteksen vallitsevuus oli korkein intialaisilla ja matalin eurooppalaisilla. Etnis- ja sukupuoli-kohtainen painoindeksin ja vyötärön ympärysmitan raja-arvoja tulee soveltaa ennustettaessa diabeteksen riskiä liittyen lihavuuteen.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The aim of this study was to assess the mortality rate and risk of death in relation to the blood pressure (BP) categories during 36 years of follow-up period. Methods 265 healthy middle-aged participants were included in the follow up for 36 years; 136 deaths occurred during this time. Causes of death (myocardial infarction (MI), stroke and other causes) were obtained from the death certificates. Participants were divided into four groups according to their blood pressure measurements (normal blood pressure, prehypertension, stage I and stage II hypertension). Hazard ratios (HR) for mortality from all investigated causes of death were calculated using measurements of normal BP as a reference. Kaplan-Meier method was used to calculate probability of survival for each BP category. Results Participants with prehypertension and stage I hypertension have shared similar all-cause mortality rates (15 deaths per 1000 person-years), and MI mortality rates (7 per 1000 person-years). Participants with stage II hypertension had the highest risk of all-cause mortality (HR 2.78, 95% confidence interval 1.16 to 6.66). Conclusion Prehypertension and stage I hypertension induced similar rates of mortality due to myocardial infarction or all-causes. The survival probabilities were lower for participants with hypertension and prehypertension in comparison with those who had normal blood pressure. Participants with stage II hypertension had the highest mortality rates and the lowest probability of survival during a 36-year follow-up period.
    Central European Journal of Medicine 04/2012; 8(2). DOI:10.2478/s11536-012-0105-x · 0.15 Impact Factor
Show more