Effect of Drug and Diet Treatment of Mild Hypertension on Diastolic Blood Pressure

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 17; no. 2; pp. 210 - 217
• Main Authors: Langford, Herbert G, Davis, Barry R, Blaufox, Donald, Oberman, Albert, Wassertheil-Smoller, Sylvia, Hawkins, Morton
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.02.1991; Hagerstown, MD Lippincott
• Subjects: Antihypertensive agents; Biological and medical sciences; Cardiovascular system; Medical sciences; Pharmacology. Drug treatments; Diuretic; Human; Hypertension; Chemotherapy; Diet therapy; Multicenter study; Antihypertensive agent; Cardiovascular disease; Thiazide; Beta blocking agent
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.17.2.210

The Trial of Antihypertensive Interventions and Management is a multicenter randomized trial designed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension (diastolic blood pressure 90-100 mm Hg). Eight hundred and seventy-eight participants at 110-160% of ideal weight were randomly allocated to nine drug/diet treatment groups receiving either a placebo, chlorthalidone (25 mg), or atenolol (50 mg), combined with a usual, a weight loss, or a low sodium/high potassium diet The primary outcome was diastolic blood pressure change from baseline to 6 months. Seven hundred and eighty-seven participants had follow-up data. The mean baseline diastolic blood pressure was 93.8 mm Hg; 55.9% of the participants were male, and the weight loss diet group lost an average of 4.7 kg. Multiple comparisons were accounted for in the analysis. A significantly greater lowering of diastolic blood pressure (12.4 mm Hg) was achieved in the atenolol group compared with either the low sodium/high potassium diet group (7.9 mm Hg, p=0.001) or weight loss group (8.8 mm Hg, p=0.006). Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering (15.1 mm Hg) when compared with the diuretic alone (10.8 mm Hg, p=0.002), but adding a low sodium/high potassium diet (12.2 mm Hg, p=0.029) did not In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration, drugs outperform diet, and weight loss is beneficial, especially with diuretics.