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

Victor J. Stevens, PhD; Eva Obarzanek, PhD; Nancy R. Cook, ScD; I-Min Lee, MD, ScD; Lawrence J. Appel, MD, MPH; Delia Smith West, PhD; N. Carole Milas, MS, RD; Mildred Mattfeldt-Beman, PhD; Lorna Belden, MS, RD; Charlotte Bragg, MS, RD; Marian Millstone, MS; James Raczynski, PhD; Amy Brewer, MS, RD; Bali Singh, MS, RD; Jerome Cohen, MD, Trials of Hypertension Prevention Research Group
[+] Article and Author Information

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.


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@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.


Ann Intern Med. 2001;134(1):1-11. doi:10.7326/0003-4819-134-1-200101020-00007
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Approximately one fourth of the U.S. adult population—nearly 50 million people—has hypertension (12). Taking a broader perspective, more than half of the adult population has higher than optimal blood pressure (1), defined as systolic blood pressure greater than 120 mm Hg and diastolic blood pressure greater than 80 mm Hg (2). These persons are at significantly increased risk for cardiovascular disease and stroke (3). Although pharmacologic treatment for hypertension significantly reduces morbidity and mortality from cardiovascular diseases (45), long-term pharmacologic therapy can have undesirable side effects and requires the expense of continuing medical supervision. Furthermore, pharmacologic therapy is not usually initiated when blood pressure is higher than optimal yet below diagnostic thresholds for hypertension. Thus, lifestyle interventions for primary prevention and initial treatment of high blood pressure remain a vital strategy for controlling this highly prevalent condition (2).

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Figures

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Figure 1.
Mean change in weight over 36 months.

Dotted lines represent the weight loss group; solid lines represent the usual care group. Error bars represent 95% CIs.

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Figure 2.
Mean change in blood pressure.

White bars represent diastolic blood pressure; gray bars represent systolic blood pressure. Error bars represent 95% CIs. Data are adjusted for age, ethnicity, and sex according to quintile of weight change at 36 months (weight loss and usual care groups combined).

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Grahic Jump Location
Figure 3.
Mean change in diastolic (top) and systolic (bottom) blood pressure.

Data are adjusted for age, ethnicity, and sex, according to patterns of weight change. Usual care controls were not assigned to intervention. Participants with successful maintenance of weight loss were defined as those who lost 4.5 kg or more at 6 months and maintained at least 4.5 kg of weight loss at 36 months. Participants with relapse were those who lost at least 4.5 kg at 6 months but whose weight loss at 36 months was less than 2.5 kg. Participants with no weight loss had weight loss of 2.5 kg or less at 6 and 36 months. Error bars represent 95% CIs.

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Summary for Patients

The Effects of Weight Loss on Blood Pressure

The summary below is from the full report titled “Long-Term Weight Loss and Changes in Blood Pressure: Results of the Trials of Hypertension Prevention, Phase II.” It is in the 2 January 2001 issue of Annals of Internal Medicine (volume 134, pages 1-11). The authors are VJ Stevens, E Obarzanek, NR Cook, I-M Lee, LJ Appel, D Smith West, NC Milas, M Mattfeldt-Beman, L Belden, C Bragg, M Millstone, J Raczynski, A Brewer, B Singh, and J Cohen.

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