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Interaction between physical activity and diet: implications for blood pressure management in primary care

Published online by Cambridge University Press:  02 January 2007

BM Margetts ,
P Little  and
D Warm
BM Margetts*
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Level B, South Academic Block, SO16 6YD Southampton, UK
P Little
Affiliation:
Department of Primary Medical Care, University of Southampton, Southampton General Hospital, Level B, South Academic Block, SO16 6YD, Southampton, UK
D Warm
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Level B, South Academic Block, SO16 6YD Southampton, UK Unit for Preventive Nutrition, Karolinska Institute, Sweden
*
*Corresponding author: Email: [email protected]
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Abstract

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Objectives:

This review summarises the evidence for the effectiveness of primary care based interventions of diet and physical activity aimed at reducing blood pressure.

Background:

As blood pressure rises so does the risk of heart disease and stroke. There is a large literature on the effects on blood pressure of changing various aspects of diet either as single nutrient interventions, patterns of food consumption, or the addition of dietary supplements (potassium, magnesium, and fish oil). Controlled trials have been undertaken to assess the relative benefits of lifestyle changes in activity (walking etc) compared with more structured exercise programmes. There is sufficient evidence to suggest that changes in diet and activity under controlled conditions can reduce blood pressure and delay or reduce the need for drug treatment in subjects who are hypertensive. What is less clear is how to achieve these lifestyle changes in the primary care setting as part of routine clinical management.

Results:

There have been a number of systematic reviews undertaken to evaluate the evidence. The interventions were either delivered alone or in combination with other advice, either with or without aids, and by various practice nurse staff (GP, nurse, Dietitian); follow-up varied from 3 months to a year. Compliance with the advice was generally not measured. The variability in the quality of the studies and interventions made it difficult to draw conclusions: any effects seen tended to be small.

Conclusions:

Equivocal results (non statistically significant reductions) should not be considered as proof of no effect without careful consideration of the effects of chance, bias and confounding, and without better measures of compliance. There is little debate that, under investigator control, blood pressure can be reduced by changes in diet and activity. Changes to a ‘healthy’ diet (low in total and saturated fat; energy intake balanced with expenditure to maintain or achieve optimal body weight; low in salt; high in fruits, vegetables, legumes; and whole grains) and increases in modest levels of physical activity (walking etc) would be expected to reduce blood pressure by between two and four mmHg. A shift in the population distribution of this order would be expected to have a substantial impact on population mortality patterns and could be achieved cost-effectively in primary care.

Keywords

NutritionPhysical activityDietExerciseBlood pressurePrimary careInterventionsReview
Type
Research Article
Information
Public Health Nutrition , Volume 2 , Supplement 3a , March 1999 , pp. 377 - 382
Copyright
Copyright © CABI Publishing 1999

References

1Uemura, K, Pisa, Z, trends in cardiovascular disease mortality in industrialised countries since 1950. Wld Hlth Statist Quart. 1988; 41: 155–168.Google Scholar
2Murray, CJL, Lopez, AD, eds. The Global Burden of Disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. World health Organization, Harvard University Press, 1996.Google Scholar
3 World health Organization. The World Health Report 1997. Geneva, World health Organization 1997.Google Scholar
4 World health Organization. The World Health Report 1998. Geneva, World health Organization 1998.Google Scholar
5 WHO-ISH Hypertension guidelines Committee. 1999 World health Organization-International Society of Hypertension Guidelines for the Management of Hypertension.Google Scholar
6Burt, VL, Cutler, JA, Higgins, M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the Health Examination Surveys, 1960–1991. Hypertension 1995; 26: 60–69.CrossRefGoogle Scholar
7Colhoun, Hm, Dong, W, Poulter, NR. Blood pressure screening, management and control in England: results from the Health survey for England. J. Hypertens 1998; 16: 747–752.CrossRefGoogle ScholarPubMed
8Mosterd, A, D'Agostino, RB, Silbershatz, H, et al. Trends in the prevalence of hypertension, antihypertensive therapy, and left ventricular hypertrophy from 1950 to 1989. N. Engl. J. Med. 1999; 340: 1221–1227.CrossRefGoogle ScholarPubMed
9de Lorgeril, M, Salen, P, Martin, J-L, Monjuad, I, Delaye, J, Mamelle, N. Mediterranean Diet, Traditional Risk Factors, and the rate of Cardiovascular Complications After Myocardial Infarction. Final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–785.CrossRefGoogle ScholarPubMed
10Ascherio, A, Rimm, EB, Hernan, MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998; 352(suppl 3): 15–8.Google Scholar
11Suter, PM, The effects of potassium, magnesium, calcium, and fiber on risk of stroke. Nutrition Reviews 1999; 57: 84–91.Google ScholarPubMed
12Barker, DJP. Mothers, Babies and Health in Later Life. Second edition. Edinburgh, Churchill Livingstone 1998.Google Scholar
13Brunner, E, White, I, Thorogood, M, Bristow, A, Curle, D, Marmot, M. Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials. Am. J. Public Health 1997; 87: 1415–1422.CrossRefGoogle ScholarPubMed
14Mulrow, C, Jackson, R. Managing primary hypertension. Clinical Evidence 1999 (in press).Google Scholar
15Law, MR. Epidemiological evidence on salt and blood pressure. Am. J. hypertens. 1997; 10: 42s–45s.CrossRefGoogle ScholarPubMed
16Cutler, JA, Follman, D, Elliot, P, Suhl, I, An overview of randomized trials of sodium reduction and blood pressure. Hypertension 1991; 17(suppl I): 27–33.CrossRefGoogle ScholarPubMed
17Cappuccio, FP, MacGregor, GA. Does potassium supplementation lower blood pressure? A meta analysis of published trials. J. Hypertens. 1991; 9: 465–473.CrossRefGoogle ScholarPubMed
18Cappuccio, FP, Siano, A, Strazzullo, P. Oral calcium supplementation and blood pressure: an overview of randomized controlled trials. J. Hypertens. 1991; 7: 941–946.CrossRefGoogle Scholar
19Feldman, EB. Nonpharmacologic interventions successfully treat hypertension in older persons. Nutrition reviews 1998; 56: 341–343.CrossRefGoogle ScholarPubMed
20Beilin, LJ, Rouse, IL, Armstrong, BK, Margetts, BM, Vandongen, R. Vegetarian diet and blood pressure levels: incidential or caual association. Am. J. Clin. Nutr. 1988; 48: 806–10.CrossRefGoogle ScholarPubMed
21Margetts, BM, Beilin, LJ, Vandongen, R, Armtstrong, BK. Vegatarian diet in mild hypertension: a randomized controlled trial. BMJ 1986; 293: 1468–1471.CrossRefGoogle Scholar
22Appel, LJ, Moore, TJ, Obarzanek, E, et al. A clinical trial of dietay patterns on blood pressure. N. Engl. J. Med. 1997; 336: 1117–24.CrossRefGoogle Scholar
23Svetky, LP, Simons–Morton, D, Vollmer, WM, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch. Int. Med. 1999; 159: 285–93.CrossRefGoogle Scholar
24Whelton, PK, Appel, LJ, Espeland, MA, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons. A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA 1998; 279: 839–846.CrossRefGoogle Scholar
25Bao, DG, Mori, TA, Burke, V, Puddey, IB, Beilin, LJ. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. Hypertension 1998; 32: 710–717.CrossRefGoogle ScholarPubMed
26Hillsdon, M, Thorogood, M. A systematic review of physical activity promotion strategies. Br. J. Sports Med. 1996; 30: 84–89.CrossRefGoogle ScholarPubMed
27Berlin, JA, Colditz, GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am. J. Epidemiol. 1990; 132, 31: 639–646.CrossRefGoogle ScholarPubMed
28Dunn, AL, marcus, BH, Kampert, JB, garcia, ME, Kohl, HW 3rd, Blair, SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA 1999; 281: 327–334.CrossRefGoogle ScholarPubMed
29Roe, L, Hunt, P, Bradshaw, H, Rayner, M. health promotion interventions to promote healthy eating in the general population: a review. London, Health Education Authority, 1997.Google Scholar
30Ebrahim, S, Smith, GD. Systematic review of randomized controlled trials of multiple risk factor interventions for preventing coronary heart disease. Br. Med. J. 1997; 314: 16666–166674.CrossRefGoogle ScholarPubMed
31Little, P, Margetts, BM. The importance of diet and physical activity in the treatment of conditions managed in general practice. Br. J. Gen. Prac. 1996; 46: 187–192.Google ScholarPubMed
32Ashendon, R, Silagy, C, Weller, D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Family Practice 1997; 14: 160–176.CrossRefGoogle Scholar
33Campbell, NC, Ritchie, LD, Thain, J, deans, HG, Rawles, JM, Squair, JL. Secndary prevention in coronary heart disease: a randomized trial of nurse lead clinics in primary care. Heart 1998; 80: 447–452.CrossRefGoogle Scholar
34 Family Heart Study. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British family heart study. BMJ 1994; 308: 313–320.CrossRefGoogle Scholar
35Roderick, P, Ruddock, V, Hunt, P, Miller, G. A randomized trial to evaluate the effectiveness of dietary advice by practice nurses in lowering diet-induced coronary heart disease risk. Br. J. Gen. Prac. 1997; 47: 7–11.Google Scholar
36 Imperial Cancer Research Fund OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year. BMJ 1994; 309: 308–312.Google Scholar
37Pritchard, DA, Hyndman, J, Taba, F. Nutritional counselling in general practice: a cost effective analysis. J. Epidemiol. Com. Hlth 1999; 53: 311–316.CrossRefGoogle ScholarPubMed
38Adams, JL, Fitzmaurice, DA, Heath, CM, et al. A novel method of guideline devlopment for the diagnosis and managemement of mild to moderate hypertension. Br. J. Gen. Prac. 1999; 49: 175–179.Google Scholar
39Thompson, RL, Margetts, BM, Speller, VM, McVey, D. The Health Education Authority's health and lifestyle survey 1993: who are the low fruit and vegetable consumers? J. Epidemiol. Com. Hlth 1999; 53: 294–299.CrossRefGoogle ScholarPubMed
40Stevens, W, Hillsdon, M, Thorogood, M, McArdle, D. Cost-effectiveness of a primary care based physcial activity intervention in 45–74 year old men and women: a randomized controlled trial. Br. J. Sports Med. 1998; 32: 236–241.CrossRefGoogle Scholar
41McKenna, J, Naylor, P-J, McDowell, N. Barriers to physical activity promotion by general practitioners and practice nurses. Br. J. Sports Med. 1998; 32: 242–247.CrossRefGoogle ScholarPubMed
42McAvoy, BR, Kaner, EFS, Lock, CA, Heather, N, Gilvarry, E. Our Healthier Nation: are general prcatitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling. Br. J. Gen. Prac. 1999; 49: 187–190.Google ScholarPubMed
43Little, P, Barnett, J, Margetts, BM, et al. The validity of dietary assessment in general practice. J. Epidemiol. Com. Hlth 1999; 53: 165–172.CrossRefGoogle ScholarPubMed
44Roe, L, Strong, C, Whiteside, C, Neil, A, Mant, D. Dietary intervention in primary care: validity of the DINE method of diet assessment. Family Practice 1994; 11: 375–381.CrossRefGoogle ScholarPubMed