Long-term Diet and Lifestyle Changes for Control of Mild Hypertension. The Treatmement of Mild Hypertension Stud (TOMHS)

Patricia J. Elmer, B. Laing, N. VanHeel, Gregory A Grandits, R. Grimm, J. Raines, C. Lewis, E. Betz, M. Link, J. Stamler

Research output: Contribution to journalArticlepeer-review


There is considerable interest in the feasibility of incorporating nutritional and lifestyle changes into blood pressure treatment and cardiovascular disease risk reduction programs in clinical practice settings. TOMHS was a multi-center, randomized trial comparing a non-drug lifestyle intervention plus placebo with 5 groups receiving the lifestyle intervention plus one of five active antihypertensive drugs. Participants were 902 men and women, age 45-69, with mild hypertension (DPB 90-99 mmHg.) All patients received diet and lifestyle intervention provided by registered dietitians through a series of group and individual sessions. The program included an initial 6 month intensive education program followed by at least quarterly individual assessment and counseling sessions with the dietitians. The goals were: weight loss ≥ 10 lbs.; 25% reduction in dietary sodium; 150 minutes/week of moderate physical activity (600 kcal); <2 alcoholic drinks/day. After one year, significant lifestyle changes were achieved and a large % of the changes were maintained for 4 years. At 2 years 81% of the initial weight loss was maintained and at 4 years, 50%. At one year, patients had increased their leisure time physical activity (PA) by 82% (430 kcal/wk) and after 4 years nearly 1/2 of this increase in physical activity was maintained. Walking, fast walking, bicycling, and calisthenics were die most common activities. Walking accounted for 60% of the total increase in PA. Greater ↑ in PA were associated with greater weight loss. After adjustment for weight loss ↑ PA was also associated with greater ↑ in HDL and ↓ in TG in men only. {A table is presented}. In the patients receiving the lifestyle intervention alone (placebo group), SBP fell by 10.4 mmHg and DBP by 9.4 mmHg and DBP was controlled (<95 mmHg) without medications in 59% of this group over 4 years. Serum lipids also improved; the magnitude of change was related to amount of wt. loss. These data show major lifestyle changes can be achieved and maintained in mildly hypertensive patients through systematic dietitian-delivered lifestyle intervention programs. Program components and project evaluation information will be presented.

Original languageEnglish (US)
Pages (from-to)A50
JournalJournal of the American Dietetic Association
Issue number9 SUPPL.
StatePublished - Sep 1995


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