The Long-Term Effects of Lifestyle Change on Blood Pressure: One-Year Follow-Up of the ENCORE Study

• Published in: American journal of hypertension 2014-05, Vol.27 (5), p.734-741
• Main Authors: Hinderliter, Alan L., Sherwood, Andrew, Craighead, Linda W., Lin, Pwa-Hwa, Watkins, Lana, Babyak, Michael A., Blumenthal, James A.
• Format: Article
• Language: English
• Subjects: Adult; Behavior; Blood Pressure; Caloric Restriction; Cognitive Therapy; Confidence intervals; Drug therapy; Exercise Therapy; Feeding Behavior; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Hypertension - diagnosis; Hypertension - physiopathology; Hypertension - prevention & control; Intervention; Life Style; Male; Middle Aged; North Carolina; Original; Overweight - diagnosis; Overweight - physiopathology; Overweight - therapy; Risk Factors; Risk Reduction Behavior; Sedentary Lifestyle; Studies; Time Factors; Treatment Outcome; Weight Loss; Weight Reduction Programs
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpt183

BACKGROUND There is a paucity of data describing the sustained benefits of lifestyle interventions on health behaviors and blood pressure (BP). METHODS We examined the persistence of changes in health habits and BP in the ENCORE study, a trial in which 144 overweight individuals with above-normal BP were randomized to one of the following 16-week interventions: Dietary Approaches to Stop Hypertension (DASH) diet alone (DASH-A), DASH diet plus a behavioral weight management intervention (DASH-WM), or Usual Care. Follow-up assessments were conducted 8 months after the end of treatment. RESULTS At 16 weeks, systolic BP was reduced by 16.1 (95% confidence interval (CI) = 13.0-19.2) mm Hg in the DASH-WM group, 11.2 (95% CI = 8.1-14.3) mm Hg in the DASH-A group, and 3.4 (95% CI = 0.4-6.4) mm Hg in the Usual Care group. A decrease in BP persisted for 8 months, with systolic BP lower than baseline by 11.7 (95% CI = 8.1-15.3) mm Hg in the DASH-WM group, 9.5 (95% CI = 6.7-12.1) mm Hg in the DASH-A group, and 3.9 (95% CI = 0.5-7.3) mm Hg in the Usual Care group (P < 0.001 for active treatments vs. Usual Care). DASH-WM subjects lost 8.7kg during the intervention and remained 6.3kg lighter on follow-up examination. Changes in diet content were sustained in both DASH intervention groups. Among those who participated in DASH-WM, however, caloric intake was no longer lower, and only 21% reported still exercising regularly 8 months after completing the intervention. CONCLUSIONS Changes in dietary habits, weight, and BP persisted for 8 months after completion of the 16-week ENCORE program, with some attenuation of the benefits. Additional research is needed to identify effective methods to promote long-term maintenance of the benefits of lifestyle modification programs. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00571844.