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Motivation In Blood Pressure Control

The power of persuasion is a key factor in helping to lower blood pressure in patients with hypertension. Researchers have discovered that persuasion, combined with traditional lifestyle factors such as weight loss, regular exercise, and limiting sodium, alcohol, and dietary fat have all been shown to help lower blood pressure in patients with hypertension.

Whether it's a doctor's advice on the importance of blood pressure control or the social support and specific strategies gained in regular meetings with other patients, researchers say that encouraging words seem to help people reduce their blood pressure and weight.

"Motivation was definitely one of several very important behavior elements in helping to control blood pressure," says researcher Laura P. Svetkey, MD, director of the Hypertension Center at Duke University School of Medicine. "A little nudge in the right direction seems to go a long way in helping people lose weight, increase their physical activity, and eat healthier to lower their blood pressure and reduce risk of cardio-vascular disease. And if it only takes a little nudge to get people motivated to be on the right track, that's terrific."

In her study, published in the Journal of the American Medical Association, she and her colleagues examined whether adding a heart-healthy diet called DASH would further reduce blood pressure in people also following healthy lifestyle factors.

The DASH diet - Dietary Approaches to Stop Hypertension - is a low-fat diet rich in fruits, vegetables, and low-fat dairy products and is designed to lower blood pressure.

About 800 people were divided into one of three groups.

  • The first group followed healthy lifestyle changes.
  • The second group also followed these lifestyle changes and added the DASH diet.
  • The third group only received general advice from counselors.

The results: The DASH diet had only a minor additional effect in reducing blood pressure. "We were expecting to see a bigger difference between those eating the DASH diet as part of their intervention compared to those who did everything else but eat that diet" Svetkey declares. "It could be that there is only so much bang you can get from a combination of lifestyle interventions. But the social support that both groups got seemed to really help. People helped each other and came up with specific strategies, such as how to resist eating all those cakes and cookies during the holiday season."

But the real surprise came from the 273 "control" patients who got no specific guidance or group support - and had only occasional meetings with an intervention counselor who advised them on the importance of reaching those goals, but offered no specific strategies to do it.

By study's end, they lowered their blood pressure an average of nearly seven points and averaged about three pounds of weight loss, compared to less than six pounds lost by those in the other two groups.

What's more, nearly 20% in this "advice-only" group reached optimal blood pressure levels by study's end, compared with 30% of those following lifestyle changes or 35% of those eating the DASH diet and following lifestyle changes.

"What was surprising was how well (the advice-only) group did," Svetkey says. "They did much better than a control group did in a similar study." The bottom line, she says: Any type of encouragement may be helpful to instill or continue motivation - even "generic" advice on why blood pressure control is important but offering no specific strategies.

And that's why in an accompanying editorial, one expert says doctors should continue to counsel high blood pressure patients on the importance of losing weight with diet and exercise. But he says that he's not ready to discount the DASH diet.

In previous studies, those eating this diet had all their meals prepared for them. In Svetkey's study, they were given the dietary guidelines but had to cook for themselves, so researchers couldn't tell how closely their patients followed the DASH diet.

"Something like the DASH diet does have additional benefits apart from lowering blood pressure," says Thomas G. Pickering, MD, PhD, of Mount Sinai Medical Center, who didn't participate in Svetkey's study.

"It is generally thought to be a healthy diet that can reduce the risk of heart disease, diabetes, and possibly cancer. If a patient is overweight, the key to blood pressure control is to lose weight, and DASH is one way to do that. From this study, you couldn't really tell how compliant people were to DASH."

"What this study tells you is that if people want to lose weight, they will lose weight," says another study researcher, Catherine Champagne, PhD, of Pennington Bio-medical Research Center. "They will lose more weight if they have more intensive intervention. But the fact that the control group that didn't get this social support but still met with an intervention specialists didn't gain weight during our trial - and in fact, lost it - tells you they were highly motivated. And that motivation certainly helps."

06/25/03





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