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It is well known that an unhealthy diet and physical inactivity are related to elevated blood pressure; the challenge for physicians is helping patients make and maintain multiple lifestyle changes. The PREMIER randomized trial showed that a comprehensive behavioral intervention program emphasizing changes in diet and physical activity led to a clinically significant reduction in blood pressure after six months. Elmer and colleagues compared how the PREMIER interventions (i. e., two behavioral interventions and an advice-only intervention) affected blood pressure after 18 months.
The study included 810 otherwise healthy adult volunteers 25 years or older who had prehypertension (i. e., systolic blood pressure, 120 to 139 mm Hg; and diastolic blood pressure, 80 to 89 mm Hg) or stage 1 hypertension (i. e., systolic blood pressure, 140 to 159 mm Hg; or diastolic blood pressure, 90 to 95 mm Hg) averaged over three screening visits. Participants were excluded if they were taking antihypertensive or prescription weight loss medications; had a body mass index (BMI) less than 18.5 kg per m^sup 2^ or more than 45 kg per m^sup 2^; consumed more than 21 alcoholic...