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Methodological issues when evaluating lifestyle interventions for raised blood pressure

Lookup NU author(s): Dr Heather Dickinson, Donald Nicolson, Dr Fiona CampbellORCiD, Professor James Mason


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Objective: To inform a national guideline development group about the effectiveness of lifestyle interventions to reduce hypertension. Methods: Included RCTs compared diet, exercise, relaxation, restriction of alcohol and salt with control interventions or no treatment. Participants had blood pressure ≥140/85 mmHg and ≥8 weeks follow-up. Relevant studies were identified from existing systematic reviews and by searching electronic databases from 1998 onwards. Meta-analyses estimated weighted mean differences using a random effects model. Results: We found 50 studies of 4,802 patients, typically of 3-12 months duration. All interventions achieved small short-term reductions in blood pressure and had similar withdrawal. Trials often had multiple treatment and control arms: the effect of different methodological approaches to these was investigated. We also explored whether updating published systematic reviews modified conclusions. The guideline group wanted to explore distribution of benefit, such as the proportion achieving a worthwhile reduction in blood pressure (e.g. 10/10mmHg), although the precision of this estimate may limit its usefulness. Conclusions: Lifestyle interventions of low calorie diet, aerobic exercise, relaxation, restriction of alcohol and salt can effect a modest reduction in blood pressure. The guideline group required interpretation of evidence beyond that found in Cochrane reviews.

Publication metadata

Author(s): Dickinson H, Nicolson DJ, Campbell F, Mason J

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: XI Cochrane Colloquium: Evidence, Health Care and Culture

Year of Conference: 2003