© 1998 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
research-article |
Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions
Shah Ebrahim, Professor of Clinical Epidemiology
George Davey Smith, Professor of Clinical Epidemiology
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine Rowland Hill Street, London NW3 2PF
Department of Social Medicine, University of Bristol Canynge Hall, Whiteladies Road, Bristol BS8 2PR
Address correspondence to Professor Ebrahim.
BACKGROUND: Risk factors for raised blood pressure include obesity, physical inactivity, high dietary salt intake, stress, and high alcohol consumption. Much less is known about the effects on blood pressure of modification of these risk factors for the purposes of disease prevention. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of various non-pharmacological interventions on blood pressure.
METHODS: RCTs of single interventions aimed at altering these risk factors among adults aged 45 or older with and without hypertension, and with at least six months follow-up were included. MEDLINE was the primary source and the boundaries of the study were from 1966 to April 1995.
RESULTS: The majority of RCTs were of short duration and did not provide guidance on the sustainability of effects and were excluded. Totals of eight RCTs of salt restriction, eight RCTs of weight reduction, eight of stress management, eight of exercise, and one of alcohol reduction of longer than six months duration were found. Net (i.e. intervention - control group) systolic blood pressure changes, mean mmHg (with 95 per cent confidence intervals in parentheses), in hypertensives were as follows: salt restriction –2.9 (–5.8, 0.0), weight loss –5.2 (–8.3,–2.0), stress control –1.0 (–2.3,+0.3), and exercise –0.8 (–5.9,+4.2). Smaller changes were found in normotensive participants: salt restriction –1.3 (–2.7,+0.1), weight loss –2.8 (–3.9,–1.8), exercise –0.2(–2.8,+2.4), and alcohol reduction –2.1 (–4.1,–0.1). Some interventions (e.g. stress control in normotensives) were not examined in either hypertensives or normotensives. The majority of RCTs were of low methodological quality and bias often tended to increase the changes observed. Few of the trials controlled for the confounding effects of concurrent changes in other blood pressure risk factors.
CONCLUSION: These net changes are probably overestimates of the effects that might be achieved by non-pharmacological interventions. There is a need for large-scale, long duration trials of these non-pharmacological interventions in both hypertensive patients and normotensive people to determine effect sizes more accurately.
Keywords: hypertension, weight, salt, diet, exercise, meta-analysis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D A Lawlor, C J Riddoch, A S Page, L B Andersen, N Wedderkopp, M Harro, D Stansbie, and G Davey Smith Infant feeding and components of the metabolic syndrome: findings from the European Youth Heart Study Arch. Dis. Child., June 1, 2005; 90(6): 582 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. P. Svetkey Management of Prehypertension Hypertension, June 1, 2005; 45(6): 1056 - 1061. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Watkins, P. McCarron, L. Murray, G. Cran, C. Boreham, P. Robson, C. McGartland, G. D. Smith, and M. Savage Trends in blood pressure over 10 years in adolescents: analyses of cross sectional surveys in the Northern Ireland Young Hearts project BMJ, July 17, 2004; 329(7458): 139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Martin, A. R. Ness, D. Gunnell, P. Emmett, G. D. Smith, and for the ALSPAC Study Team Does Breast-Feeding in Infancy Lower Blood Pressure in Childhood?: The Avon Longitudinal Study of Parents and Children (ALSPAC) Circulation, March 16, 2004; 109(10): 1259 - 1266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Emberson, P. Whincup, R. Morris, M. Walker, and S. Ebrahim Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease Eur. Heart J., March 2, 2004; 25(6): 484 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Neter, B. E. Stam, F. J. Kok, D. E. Grobbee, and J. M. Geleijnse Influence of Weight Reduction on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials Hypertension, November 1, 2003; 42(5): 878 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Hooper, C. Bartlett, G. Davey Smith, and S. Ebrahim Systematic review of long term effects of advice to reduce dietary salt in adults BMJ, September 21, 2002; 325(7365): 628 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A Freeman and D. B Petitti Commentary: Salt, blood pressure and public policy Int. J. Epidemiol., April 1, 2002; 31(2): 319 - 320. [Full Text] [PDF]
|
|
|
|
|
|
S. Ebrahim The Desktop Guide to Complementary and Alternative Medicine: E Ernst, MH Pittler, C Stevinson, A White (eds). London: Harcourt, 2001, pp.444, {pound}24.95 (+ CD-ROM), ISBN 0-7234-3207-4. Int. J. Epidemiol., February 1, 2002; 31(1): 272 - 273. [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. LIPSHULTZ, S. D. FISHER, W. W. LAI, and T. L. MILLER Cardiovascular Monitoring and Therapy for HIV-Infected Patients Ann. N.Y. Acad. Sci., November 1, 2001; 946(1): 236 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. McCarron, M. Okasha, J. McEwen, G. D. Smith, and B. Neal Changes in blood pressure among students attending Glasgow University between 1948 and 1968: analyses of cross sectional surveys Commentary: Changing population blood pressure levels BMJ, April 14, 2001; 322(7291): 885 - 889. [Abstract] [Full Text]
|
|
|
|
|
|
N. J Wareham, M.-Y. Wong, S. Hennings, J. Mitchell, K. Rennie, K. Cruickshank, and N. E Day Quantifying the association between habitual energy expenditure and blood pressure Int. J. Epidemiol., August 1, 2000; 29(4): 655 - 660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Sjostrom, M. Peltonen, H. Wedel, and L. Sjostrom Differentiated Long-Term Effects of Intentional Weight Loss on Diabetes and Hypertension Hypertension, July 1, 2000; 36(1): 20 - 25. [Abstract] [Full Text] [PDF]
|
|