Rationale:

Prehypertension is a precursor of hypertension and an established predictor of excessive cardiovascular risk. Although national clinical guidelines promulgate therapeutic lifestyle changes (TLC) as a cornerstone in the management of prehypertension, recent research has focused on the use of pharmacotherapy due to the perceived ineffectiveness of TLC in daily clinical practice.

Objectives:

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 who were not taking antihypertensive medication (age = 48 +/- 10 years), we evaluated the clinical effectiveness of TLC in helping patients normalize their blood pressure (BP) without using drug therapy.

Methodology:

Subjects were evaluated at baseline and after an average of approximately 6 months of participation in a community-based lifestyle management program (the INTERVENT program). At baseline, all subjects met the criteria for the diagnosis of prehypertension as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), namely, a systolic BP of 120-139 mmHg and a diastolic BP <= 89 mmHg or a diastolic BP of 80-89 mmHg and a systolic BP <= 139 mmHg. Subjects did not have known atherosclerotic cardiovascular disease, diabetes, or chronic kidney disease at baseline. TLC included exercise training, nutrition, weight management, stress management, and smoking cessation interventions. All subjects remained off antihypertensive medications throughout the study.

Results:

Baseline systolic BP (125 +/- 8 mmHg) decreased by 6 +/- 12 mmHg (P <= 0.001) and baseline diastolic BP (79 +/- 3 mmHg) decreased by 3 +/- 3 mmHg (P <= 0.001) with TLC. In subjects with a baseline systolic BP of 120-139 mmHg (n = 2,082), systolic BP decreased by 7 +/- 12 mmHg (P <= 0.001) with TLC. In subjects with a baseline diastolic BP of 80-89 mmHg (n = 1,504), diastolic BP decreased by 6 +/- 3 mmHg (P <= 0.001) with TLC. Based on JNC 7 criteria, 952 (39%) subjects normalized their BP (ie, achievement of both a systolic BP <120 mmHg and a diastolic BP <80 mmHg) with TLC (P <= 0.001).

Conclusions:

The present study adds to previous research by reporting on the effectiveness (ie, extent to which TLC works in actual practice) rather than on the efficacy (ie, determining whether TLC can work when administered in a clinical trial) of TLC in patients with prehypertension. Although further research is warranted, these data clearly show that many patients with prehypertension can normalize their BP with TLC. The data have important clinical and cost-containment implications for physicians and their patients.