The reduced heart rate on the treadmill test, an objective measure of improved fitness, suggests that participants increased their physical activity, even though self-reported physical activity as measured by 7-day physical activity recalls did not change significantly.

Both behavioral interventions significantly reduced sodium intake, although not to the same extent as behavioral interventions that focused exclusively on this factor.

Across the 3 groups, gradients in BP and hypertensive status were evident. The smallest BP reduction occurred in the advice only group, while the greatest BP reduction occurred in the established plus DASH group.

These rates compare favorably with survey data 2 and trial data, 23 in which drug therapy controls BP in approximately half of hypertensive individuals. Hence, these behavioral interventions should be viable treatment options, at least among those hypertensive individuals who are motivated to make lifestyle changes.

The established and established plus DASH interventions also reduced BP in nonhypertensive individuals with above-optimal BP. Overall, this pattern of findings suggests that even in the context of other effective lifestyle modifications, adoption of the DASH diet further improves BP control.

Still, the BP effects attributed to the DASH diet, specifically the BP differences between the established plus DASH and the established interventions, were less than previously found in the DASH feeding studies, 8 , 24 and none of the contrasts in hypertension status was statistically significant.

One potential reason is that participants received an inadequate "dose" of the DASH diet. For instance, even though mean fruit and vegetable intake increased from 4. Another plausible reason is subadditivity of intervention effects. Specifically, the net BP effect of the DASH diet in the PREMIER trial likely underestimates the BP effects of the DASH diet if it were implemented alone.

Subadditivity can occur from reduced adherence 13 because of the effort and complexity of making more than 1 lifestyle change. For example, participants in the established plus DASH intervention were advised to increase their intake of dairy products while reducing total caloric intake.

Still, even in the setting of high adherence, such as feeding studies, subadditivity occurs. The advice only comparison group in the PREMIER trial likely accomplished some lifestyle modifications. Such behavior changes might have resulted from recruitment of motivated participants; secular trends eg, growing awareness of the obesity epidemic ; the minute intervention session postrandomization; and the multiple, regular data collection visits and contacts 4 visits and 2 dietary recalls at baseline; 1 visit at 3 months and 3 visits at 6 months, along with telephone calls and reminders.

Although before-after changes must be interpreted cautiously, the weight loss of 1. Such modest changes in behavior might have reduced BP in this group, thereby attenuating the pairwise differences in BP between the advice only group and the 2 behavioral interventions.

In fact, the within-group BP reductions observed in the advice only group systolic BP reduction of 6. In the PREMIER trial, the primary outcome variables were collected at 6 months postrandomization. The inclusion of hypertensive individuals in the PREMIER trial precluded use of BP measured at a later follow-up visit as the primary outcome because national guidelines recommend initiation of drug therapy for individuals with Class B hypertension who remain hypertensive after a 6-month period of nondrug therapy.

In addition to hypertension, high-normal BP is also associated with excess CVD risk. Yet most health care insurers do not cover behavioral interventions for the prevention and treatment of hypertension.

The costs of such programs should be balanced against the benefits of preventing hypertension, diabetes, heart disease, and other conditions, thereby preventing the need for medical treatments that may be costly. In summary, our trial results demonstrate the feasibility of comprehensive behavioral interventions and their beneficial effects on BP and hypertension control.

Benefits extend to both nonhypertensive individuals at risk for developing hypertension and hypertensive individuals who are not receiving medication therapy.

Although we did not study individuals receiving drug therapy, available data indicate that nonpharmacological interventions also reduce BP in these individuals. full text icon Full Text.

Download PDF Top of Article Abstract Methods Results Comment References. Figure 1. Participant Flow in the PREMIER Clinical Trial View Large Download. BP indicates blood pressure; DASH, Dietary Approaches to Stop Hypertension.

Figure 2. Mean Systolic and Diastolic Blood Pressure BP Over Time by Randomized Group View Large Download. Figure 3. Percentage of Participants With Hypertension at 6 Months by Randomized Group Among Nonhypertensive, Hypertensive, and All Participants at Baseline View Large Download.

Figure 4. Percentage of Participants With Optimal Blood Pressure at 6 Months by Randomized Group Among Nonhypertensive Participants at Baseline, Hypertensive Participants at Baseline, and All Participants View Large Download.

Table 1. Table 2. Intervention Outcomes at Baseline and at 6 Months by Randomized Group View Large Download. Table 3. Participants Meeting Intervention Goals at Baseline and at 6 Months by Randomized Group View Large Download. Table 4. Mean Between-Group Differences in Blood Pressure BP Change in All Participants, Nonhypertensive Participants, and Hypertensive Participants View Large Download.

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Results of the Diet, Exercise and Weight-loss Intervention Trial DEW-IT. Lifestyle Modification and Blood Pressure Control. See More About Hypertension Lifestyle Behaviors Diet. Select Your Interests Select Your Interests Customize your JAMA Network experience by selecting one or more topics from the list below.

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Study Participants. Trial Conduct. The same goes for exercise. Studies, including one published in the International Journal of Environmental Research and Public Health , have found that bundling exercise with being in nature or practicing mindfulness can have an added stress-lowering effect.

The Japanese practice of shinrin-yoku , or forest bathing, has been widely studied as a way of reducing depression, anxiety, and stress and increasing mindfulness. Practices like yoga also combine exercise with mindfulness, which can both relieve stress that can worsen hypertension.

The most important thing is to build healthy habits over time in a way that makes them stick as a permanent part of your lifestyle. Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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By Kaitlin Sullivan. Medically Reviewed. Chung Yoon, MD. Watch Your Salt Intake Sodium, or salt, increases blood pressure by causing the body to retain fluid, which puts strain on the heart and blood vessels, according to the American Heart Association AHA.

Editorial Sources and Fact-Checking. Resources Why Should I Limit Sodium? American Heart Association. Sodium Intake and Health. Centers for Disease Control and Prevention. June 6, Li C et al. Relationship Between Sleep and Hypertension: Findings From the NHANES — International Journal of Environmental Research and Public Health.

August Stress and Heart Health. June 21, FDA Announces Qualified Health Claim for Magnesium and Reduced Risk of High Blood Pressure. Food and Drug Administration. January 10, Ferrè S. Serum Magnesium Levels and Cardiovascular Outcomes in Systolic Blood Pressure Intervention Trial Participants.

Kidney Medicine. March 7, Banana, Raw. Department of Agriculture. October 30, Exercise: A Drug-Free Approach to Lowering High Blood Pressure.

Even gentle forms of exercise, like walking, have health benefits. See "Patient education: Exercise Beyond the Basics ". WEIGHT LOSS AND BLOOD PRESSURE.

Being overweight or having obesity increases your risk of having high blood pressure, diabetes, and cardiovascular disease. The definition of overweight and obese are based upon a calculation called body mass index BMI. You can find your BMI using an online calculator calculator 1 and calculator 2.

A person is considered overweight if their BMI is greater than 25, while a person with a BMI of 30 or greater is classified as having obesity.

People who are overweight or have obesity can see significant reductions in blood pressure with even modest weight loss. To lose weight, you must eat fewer calories and exercise more.

See "Patient education: Losing weight Beyond the Basics ". In susceptible individuals, nonsteroidal antiinflammatory drugs or "NSAIDs" such as ibuprofen and naproxen can increase blood pressure. Oral contraceptive birth control pills may increase blood pressure in some people.

Additionally, any stimulant, including those found in some decongestants, weight loss products, and illegal drugs, can increase blood pressure.

If you are regularly consuming any of these substances, you should talk to your health care provider. WHAT IF I STILL HAVE HIGH BLOOD PRESSURE? If you continue to have high blood pressure despite making lifestyle modifications including changes in your diet, exercising more, and losing weight, you may need a medication to reduce your blood pressure.

Medications for high blood pressure are discussed separately. See "Patient education: High blood pressure treatment in adults Beyond the Basics ". Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: High blood pressure in adults The Basics Patient education: Controlling your blood pressure through lifestyle The Basics Patient education: Diabetes and diet The Basics Patient education: Renovascular hypertension The Basics Patient education: High blood pressure emergencies The Basics Patient education: Vegetarian diet The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: High blood pressure in adults Beyond the Basics Patient education: High blood pressure treatment in adults Beyond the Basics Patient education: Low-sodium diet Beyond the Basics Patient education: Risks and benefits of alcohol Beyond the Basics Patient education: High-fiber diet Beyond the Basics Patient education: Exercise Beyond the Basics Patient education: Losing weight Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research upon which they are based.

Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. The editorial staff at UpToDate would like to acknowledge Norman Kaplan, MD, who contributed to an earlier version of this topic review.

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Patient education: High blood pressure, diet, and weight Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic.

Find in topic Formulary Print Share. Authors: Michael J Bloch, MD, FACP, FASH, FSVM, FNLA Jan Basile, MD Section Editor: George L Bakris, MD Deputy Editor: Karen Law, MD, FACP Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jan This topic last updated: Jul 29, HIGH BLOOD PRESSURE OVERVIEW High blood pressure, also known as hypertension, is a common condition that can lead to serious complications if untreated. Blood pressure is reported as the systolic pressure over the diastolic pressure.

Prevalence of high blood pressure Hypertension is a common health problem. DIETARY CHANGES AND BLOOD PRESSURE Making changes to what you eat can help control high blood pressure.

EXERCISE Regular exercise can lower your blood pressure even if you don't lose weight. WEIGHT LOSS AND BLOOD PRESSURE Being overweight or having obesity increases your risk of having high blood pressure, diabetes, and cardiovascular disease.

Patient education: High blood pressure in adults The Basics Patient education: Controlling your blood pressure through lifestyle The Basics Patient education: Diabetes and diet The Basics Patient education: Renovascular hypertension The Basics Patient education: High blood pressure emergencies The Basics Patient education: Vegetarian diet The Basics Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

Patient education: High blood pressure in adults Beyond the Basics Patient education: High blood pressure treatment in adults Beyond the Basics Patient education: Low-sodium diet Beyond the Basics Patient education: Risks and benefits of alcohol Beyond the Basics Patient education: High-fiber diet Beyond the Basics Patient education: Exercise Beyond the Basics Patient education: Losing weight Beyond the Basics Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

Hypertension ; e Mori TA, Burke V, Puddey IB, et al. Effect of fish diets and weight loss on serum leptin concentration in overweight, treated-hypertensive subjects. J Hypertens ; Barone Gibbs B, Hivert MF, Jerome GJ, et al. Physical Activity as a Critical Component of First-Line Treatment for Elevated Blood Pressure or Cholesterol: Who, What, and How?

It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.

Get some tips on sleeping well. Fresh garlic or garlic extract may help lower blood pressure. One review found that for people with high blood pressure, garlic supplements reduced their systolic blood pressure by up to about 5 mm Hg and their diastolic blood pressure by up to 2.

Can you eat raw garlic? Previous studies had already suggested that consuming protein may lower blood pressure in the short term.

High-protein foods include:. Anyone considering switching to a high protein diet should first speak with a doctor, as it may not be suitable for everyone. It is also essential to balance different types of protein and to balance protein foods with other items. How much protein do you need per day?

However, there is not enough evidence to confirm that most supplements can manage blood pressure. Always check with a doctor before using a supplement, as not all supplements are safe for everyone.

They may worsen other conditions or interact with existing drugs. Learn more about supplements that may lower blood pressure. A review found that consuming 30 g or more of alcohol appears to increase the heart rate for up to 24 hours.

Blood pressure, meanwhile, tends to fall for the first 12 hours but then increases. A standard drink contains around 14 grams of alcohol. Despite the hype, drinking a lot of red wine is not beneficial for heart health, according to the American Heart Association.

They suggest limiting alcohol intake to two standard drinks per day for males and one per day for females. How does alcohol affect the body?

People who usually consume 1—3 cups of coffee per day are unlikely to experience a rise in blood pressure. However, your blood pressure might go up if you consume a lot of coffee or even a small amount when you are not used to it.

In contrast, high-caffeine energy drinks may increase blood pressure and, with that, the risk of cardiovascular problems. Experts discourage the consumption of energy drinks, especially among minors with existing health conditions. If you find that caffeine is affecting how you feel, you might want to try decaffeinated coffee.

Is caffeine good or bad for health? Some research suggests that drinking milliliters ml of water within 2 hours of waking up and another ml 2 hours before bedtime may help reduce blood pressure. However, more research is needed. How much water do you need each day? Which medications can manage high blood pressure?

This will depend on the cause and any existing diagnoses you have. Sitting quietly and doing breathing exercises might help. A person with an existing diagnosis may need to take their prescribed medication. There is a strong link between salt intake and high blood pressure, and reducing salt in the diet can help lower the risk of hypertension and its complications.

How much salt do you need each day? High blood pressure increases the risk for a number of health conditions.

People can often prevent it or manage it at home through exercise, dietary choices, stress management, and other strategies. Read this article in Spanish. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

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How Well Do You Sleep? Health Conditions Discover Plan Connect. Medically reviewed by Avi Varma, MD, MPH, AAHIVS, FAAFP — By Marjorie Hecht — Updated on October 17, Exercise Manage weight Carbs Potassium and salt Heart-healthy diet Processed food Smoking Stress Dark chocolate Herbal remedies Sleep Garlic Protein Supplements Alcohol Caffeine Water Medication FAQ Summary Medications may help lower your blood pressure.

Get enough exercise. Manage weight. Cut back on sugar and refined carbohydrates. More potassium, less salt. Following a heart-healthy diet.

Limit processed food. Quit or avoid smoking. Managing stress. Eat some dark chocolate. Try these medicinal herbs. Get quality sleep. Eat garlic or take garlic extract supplements. Eat healthy high-protein foods.

Take supplements to lower blood pressure. Limit alcohol intake. Review your caffeine intake. Drink water.