Long-Term Weight Loss and Changes in Blood Pressure: Results of the Trials of Hypertension Prevention, Phase II

  1. Victor J. Stevens, PhD;
  2. Eva Obarzanek, PhD;
  3. Nancy R. Cook, ScD;
  4. I-Min Lee, MD, ScD;
  5. Lawrence J. Appel, MD, MPH;
  6. Delia Smith West, PhD;
  7. N. Carole Milas, MS, RD;
  8. Mildred Mattfeldt-Beman, PhD;
  9. Lorna Belden, MS, RD;
  10. Charlotte Bragg, MS, RD;
  11. Marian Millstone, MS;
  12. James Raczynski, PhD;
  13. Amy Brewer, MS, RD;
  14. Bali Singh, MS, RD;
  15. Jerome Cohen, MD; and
  16. for the Trials of Hypertension Prevention Research Group
  1. From Kaiser Permanente Center for Health Research, Portland, Oregon; National Heart, Lung, and Blood Institute, Bethesda, Maryland; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; University of Alabama, Birmingham, Alabama; University of Pittsburgh, Pittsburgh, Pennsylvania; St. Louis University School of Medicine, St. Louis, Missouri; University of California School of Medicine, Davis, California; University of Tennessee, Memphis, Tennessee; and University of Medicine and Dentistry of New Jersey, Newark, New Jersey.

    Abstract

    Background: Weight loss appears to be an effective method for primary prevention of hypertension. However, the long-term effects of weight loss on blood pressure have not been extensively studied.

    Objective: To present detailed results from the weight loss arm of Trials of Hypertension Prevention (TOHP) II.

    Design: Multicenter, randomized clinical trial testing the efficacy of lifestyle interventions for reducing blood pressure over 3 to 4 years. Participants in TOHP II were randomly assigned to one of four groups. This report focuses only on participants assigned to the weight loss (n = 595) and usual care control (n = 596) groups.

    Patients: Men and women 30 to 54 years of age who had nonmedicated diastolic blood pressure of 83 to 89 mm Hg and systolic blood pressure less than 140 mm Hg and were 110% to 165% of their ideal body weight at baseline.

    Intervention: The weight loss intervention included a 3-year program of group meetings and individual counseling focused on dietary change, physical activity, and social support.

    Measurements: Weight and blood pressure data were collected every 6 months by staff who were blinded to treatment assignment.

    Results: Mean weight change from baseline in the intervention group was −4.4 kg at 6 months, −2.0 kg at 18 months, and −0.2 kg at 36 months. Mean weight change in the control group at the same time points was 0.1, 0.7, and 1.8 kg. Blood pressure was significantly lower in the intervention group than in the control group at 6, 18, and 36 months. The risk ratio for hypertension in the intervention group was 0.58 (95% CI, 0.36 to 0.94) at 6 months, 0.78 (CI, 0.62 to 1.00) at 18 months, and 0.81 (CI, 0.70 to 0.95) at 36 months. In subgroup analyses, intervention participants who lost at least 4.5 kg at 6 months and maintained this weight reduction for the next 30 months had the greatest reduction in blood pressure and a relative risk for hypertension of 0.35 (CI, 0.20 to 0.59).

    Conclusions: Clinically significant long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss.

    Article and Author Information

    • Grant Support: Phase II of the Trials of Hypertension Prevention was supported by cooperative agreements HL37852, HL37924, HL37907, HL37904, HL37854, HL37849, HL37884, HL37853, HL37899, and HL37906 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

    • Requests for Single Reprints: Victor J. Stevens, PhD, Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227; e-mail, victor.j.stevens{at}kpchr.org.

    • Current Author Addresses: Dr. Stevens: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

    • Dr. Obarzanek: National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Room 8136, Bethesda, MD 20892-7936.

    • Drs. Cook and Lee: Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215.

    • Dr. Appel: Welch Center, Johns Hopkins University, 2024 East Monument Street, Suite 2-645, Baltimore, MD 21205-2223.

    • Dr. Smith West and Ms. Bragg: Division of Preventive Medicine, University of Alabama, 1717 11th Avenue South, 700 Medical Tower Building, Birmingham, AL 35294.

    • Ms. Milas: University of Pittsburgh, 130 North Bellefield Avenue, Fourth Floor, Pittsburgh, PA 15260.

    • Dr. Mattefeldt-Beman: Department of Nutrition and Dietetics, St. Louis University, 3437 Caroline Street, St. Louis, MO 63104.

    • Ms. Belden and Ms. Millstone: University of California, Davis, One Shields Avenue, Davis, CA 95616.

    • Dr. Raczynski: University of Alabama, 1717 11th Avenue, 401 Medical Tower Building, Birmingham, AL 35294.

    • Ms. Brewer: University of Tennessee, 756 Ridge Lake Boulevard, Suite 205, Memphis, TN 38120.

    • Ms. Singh: Preventive Cardiology Program, University of Medicine and Dentistry of New Jersey, Stanley S. Bergen Building, GB20, 65 Bergen Street, Newark, NJ 07107-3001.

    • Dr. Cohen: Preventive Cardiology, St. Louis University, 3525 Caroline Avenue, St. Louis, MO 63104.

    • Author Contributions: Conception and design: V.J. Stevens, E. Obarzanek, L.J. Appel, M. Mattefeldt-Beman, M. Millstone, J. Raczynski, A. Brewer, J. Cohen.

    • Analysis and interpretation of the data: V.J. Stevens, E. Obarzanek, N.R. Cook, I.-M. Lee, L.J. Appel, D. Smith West, C.N. Milas, M. Mattefeldt-Beman, M. Millstone, J. Raczynski, J. Cohen.

    • Drafting of the article: V.J. Stevens, E. Obarzanek, N.R. Cook, D. Smith West, M. Mattefeldt-Beman, B. Singh.

    • Critical revision of the article for important intellectual content: V.J. Stevens, E. Obarzanek, N. Cook, I.-M. Lee, L.J. Appel, D. Smith West, M. Mattefeldt-Beman, J. Raczynski.

    • Final approval of the article: V.J. Stevens, E. Obarzanek, N. Cook, I.-M. Lee, L.J. Appel, M. Mattefeldt-Beman, L. Belden, C. Bragg, M. Millstone, A. Brewer, J. Cohen.

    • Provision of study materials or patients: V.J. Stevens, L.J. Appel, M. Mattefeldt-Beman, L. Belden, C. Bragg.

    • Statistical expertise: N.R. Cook, I.-M. Lee.

    • Obtaining of funding: V.J. Stevens, M. Mattefeldt-Beman, J. Cohen.

    • Administrative, technical, or logistic support: V.J. Stevens, M. Mattefeldt-Beman, L. Belden.

    • Collection and assembly of data: V.J. Stevens, L.J. Appel, M. Mattefeldt-Beman, L. Belden, M. Millstone, B. Singh.

    Summary for Patients

    « Previous | Next Article »Table of Contents

    This Article

    1. Ann Intern Med January 2, 2001 vol. 134 no. 1 1-11
    1. » Abstract
    2. Figures
    3. Full Text
    4. Full Text (PDF)
      1. Summary for Patients

    Rapid Responses

    1. Submit a response
    2. No responses published

    Current Issue

    1. November 17, 2009, 151 (10)
    1. Alert me to current issues