title: COMPARISON OF WEIGHT REDUCTION WITH METOPROLOL IN TREATMENT OF HYPERTENSION IN YOUNG OVERWEIGHT PATIENTS Effects of alcohol and caloric restrictions on blood pressure and serum lipids in overweight men. Dietary Calcium Supplementation As A Treatment For Mild Hypertension Regular aerobic exercise augments endothelium-dependent vascular relaxation in normotensive as well as hypertensive subjects: role of endothelium-derived nitric oxide. Meditation training and essential hypertension: A methodological study Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study. Controlled trial of aerobic exercise in hypertension. Combinations of potassium, calcium, and magnesium supplements in hypertension. Long-term magnesium supplementation in essential hypertension. The Oslo Diet and Exercise Study (ODES): design and objectives. Blood pressure lowering in elderly subjects: a double-blind crossover study of omega-3 and omega-6 fatty acids. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension. The effects of patient characteristics and beliefs on responses to behavioral interventions for control of chronic diseases. Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension. Superiority of nonpharmacologic therapy compared to propranolol and placebo in men with mild hypertension: a randomized, prospective trial. Nutritional counselling in general practice: a cost effective analysis. Controlled trial of long-term oral calcium supplementation in essential hypertension. Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension. Effect of low energy diet and weight loss on major risk factors, central obesity and associated disturbances in patients with essential hypertension. How useful is weight reduction in the management of hypertension? Stress management training for hypertensives: Cognitive and physiological effects Lack of effect of fish oil supplementation on blood pressure in treated hypertensives. A behavioral treatment program as a therapy in the control of primary hypertension. The effect of a relaxation technique on coronary risk factors. Effect of Calcium Carbonate on Blood Pressure in Normotensive and Hypertensive People Physical training of middle-aged men with borderline hypertension. Responses of atrial natriuretic factor to long-term sodium restriction in mild to moderate hypertension. Treating hypertension with a device that slows and regularises breathing: a randomised, double-blind controlled study Antihypertensive and volume-depleting effects of mild exercise on essential hypertension. Nutritional magnesium supplementation does not change blood pressure nor serum or muscle potassium and magnesium in untreated hypertension. A double-blind crossover study. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial. Failure of exercise to reduce blood pressure in patients with mild hypertension. Results of a randomized controlled trial. EVALUATION OF THE EFFECTIVENESS OF A LOW SODIUM DIET IN THE TREATMENT OF MILD TO MODERATE HYPERTENSION Relaxation therapy for hypertension: setting‐specific effects. Prevention and Treatment of Hypertension Study (PATHS): effects of an alcohol treatment program on blood pressure. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Controlled trial of long term oral potassium supplements in patients with mild hypertension. Oral calcium supplementation reduces intraplatelet free calcium concentration and insulin resistance in essential hypertensive patients. Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Effects of magnesium supplementation in hypertensive patients: assessment by office, home, and ambulatory blood pressures. Placebo‐Controlled Trial of Potassium Supplements in Black Patients with Mild Essential Hypertension Behavioral treatment of essential hypertension: a comparison between cognitive therapy and biofeedback of heart rate. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. A randomized, controlled trial. Trial of relaxation in reducing coronary risk: four year follow up. Calcium supplementation in patients with essential hypertension: Assessment by office, home and ambulatory blood pressure Relaxation training for essential hypertension at the worksite: I. The untreated mild hypertensive. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. Blood pressure response during long-term treatment with magnesium is dependent on magnesium status. A double-blind, placebo-controlled study in essential hypertension and in subjects with high-normal blood pressure. Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. Stress management for essential hypertension: comparison with a minimally effective treatment, predictors of response to treatment, and effects on reactivity. A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Effects of guava intake on serum total and high-density lipoprotein cholesterol levels and on systemic blood pressure. Differential effects of exercise training intensity on blood pressure and cardiovascular responses to stress in borderline hypertensive humans Prevention and Treatment of Hypertension Study (PATHS). Rationale and design. The influence of oral potassium citrate/bicarbonate on blood pressure in essential hypertension during unrestricted salt intake. Comparison of relaxation techniques, routine blood pressure measurements, and self-learning packages in hypertension control. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. Comparison of single versus multiple lifestyle interventions: are the antihypertensive effects of exercise training and diet-induced weight loss additive? Non-pharmacological treatment of hypertension in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland Effects of group relaxation training and thermal biofeedback on blood pressure and related physiological and psychological variables in essential hypertension BENEFICIAL EFFECT ON BLOOD PRESSURE AND LIPID PROFILE BY PROGRAMMED EXERCISE TRAINING IN TAIWANESE PATIENTS WITH MILD HYPERTENSION The effect of a weight reduction program on cardiovascular risk factors among overweight hypertensives in primary health care Effects of self-monitored jogging on physical fitness, blood pressure and serum lipids: a controlled study in sedentary middle-aged men. Australian National Health and Medical Research Council dietary salt study in mild hypertension. Effect of stress management on blood pressure in mild primary hypertension. The blood pressure effects of calcium supplementation in humans of known sodium responsiveness. EFFECT OF CALCIUM SUPPLEMENTATION ON DIASTOLIC BLOOD PRESSURE IN YOUNG PEOPLE WITH MILD HYPERTENSION [Effect of an oral calcium supplement in the treatment of slight-to- moderate essential arterial hypertension]. Effect of magnesium supplementation on blood pressure and electrolyte concentrations in hypertensive patients receiving long term diuretic treatment. Combined behavioral and pharmacological treatment of essential hypertension Feasibility of a long-term low-sodium diet in mild hypertension. Behavioral and physiological effects of a beta blocker and relaxation therapy on mild hypertensives. Double-blind randomized, crossover trial of calcium supplementation in essential hypertension. Relaxation and stress management in the treatment of essential hypertension. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension Dietary treatment of patients with mild to moderate hypertension in a general practice: a pilot intervention study (1). The first three months. Effect of selected yogic practices on the management of hypertension. Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. The effect of fish oil supplements on blood pressure. BP changes in obese hypertensive subjects during rapid weight loss. Comparison of restricted v unchanged salt intake. Relaxation therapy and high blood pressure. Treatment of Hypertension with Biofeedback and Relaxation Techniques Fish oil as an adjuvant in the treatment of hypertension. [Psychological nondrug treatment of hypertension and the criteria of its effectiveness]. Blood pressure response to oral calcium in persons with mild to moderate hypertension. A randomized, double-blind, placebo-controlled, crossover trial. The effect of intensified diet counseling on the diet of hypertensive subjects in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland. Dieting to reduce body weight for controlling hypertension in adults. Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group. The effects of low doses of n-3 fatty acid supplementation on blood pressure in hypertensive subjects. A randomized controlled trial. Treatment of mild hypertension with progressive muscle relaxation. Predictive value of indexes of sympathetic tone. Psychological treatment of essential hypertension: A controlled comparison of meditation and meditation plus biofeedback Paranormal healing and hypertension Autogenic training in the treatment and secondary prevention of essential hypertension: five-year follow-up. Can general practitioners use training in relaxation and management of stress to reduce mild hypertension? What types of hypertensives respond better to mild exercise therapy? Effects of a low-salt diet and of acute salt loading on blood pressure and intralymphocytic sodium concentration in young subjects with borderline hypertension. Efficacy of relaxation techniques in hypertensive patients. Calcium treatment of essential hypertension in elderly patients evaluated by 24 H monitoring. Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo Diet and Exercise Study (ODES). The accumulative effects of physical activity in hypertensive post-menopausal women. Treating Type A behaviours and mild hypertension in middle-aged men. MAGNESIUM SUPPLEMENTATION IN MILD HYPERTENSIVE PATIENTS ON A MODERATELY LOW SODIUM DIET Does baseline serum total calcium level influence the blood pressure response to calcium supplementation? A double-blind study. Effect of oral calcium supplementation on blood pressure in patients with previously untreated hypertension: a randomised, double-blind, placebo-controlled, crossover study. Effects of education and relaxation training with essential hypertension patients. Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. The cumulative dose response effect of eicosapentaenoic and docosahexaenoic acid on blood pressure, plasma lipid profile and diet pattern in mild to moderate essential hypertensive black patients. Controlled evaluation of thermal biofeedback in treatment of elevated blood pressure in unmedicated mild hypertension The antihypertensive effects of fish oil. A controlled study of polyunsaturated fatty acid supplements in essential hypertension. Effect of eicosapentaenoic and docosahexaenoic acids on blood pressure in hypertension. A population-based intervention trial from the Tromsø study. Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension. Relaxation behavior therapy as sole treatment for mild hypertension. Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice.
abstract: Weight reduction was compared with metoprolol ( 200 mg daily ) in a r and omised placebo-controlled trial of first-line treatment of mild hypertension ( diastolic blood pressure 90 - 109 mm Hg ) in 56 overweight patients aged under 55 years . After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg . The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group ( 7 mm Hg ) but not different from that in the metoprolol group ( 10 mm Hg ) . Their fall in diastolic pressure ( 10 mm Hg ) was greater than that in both the metoprolol ( 6 mm Hg ) and placebo ( 3 mm Hg ) groups . At the end of the follow-up period 50 % of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg . In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol ; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol . Thus in this study population weight reduction produced significant and clinical ly important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS The blood pressure responses of 19 mildly hypertensive ( diastolic blood pressure 90–104 mmHg ) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month r and omized , double-blind , placebo-controlled crossover study . Both groups showed a decrease in blood pressure  ( calcium treated : 6 ± 12 mmHg systolic , 7 ± 7 mmHg diastolic ; and placebo controlled : 9 ± 14 mmHg systolic , 9 ± 8 mmHg diastolic ) . Differences between the two groups were not significant ( P > 0.1 ) . There were no adverse effects to either treatment . This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals BACKGROUND Several nonpharmacological interventions , including exercise , are recommended in primary prevention of hypertension and other cardiovascular diseases in which the pathogenetic role of endothelial dysfunction has been suggested . We studied the effects of long-term aerobic exercise on endothelial function in patients with essential hypertension . METHODS AND RESULTS The forearm blood flow was measured by strain-gauge plethysmography . The responses of forearm vasculature to acetylcholine were smaller in the hypertensive patients than in the normotensive subjects . There was no significant difference in forearm vascular responses to isosorbide dinitrate in the normotensive and hypertensive subjects . We evaluated the effects of physical exercise for 12 weeks on forearm hemodynamics in untreated patients with mild essential hypertension who were divided r and omly into an  exercise group ( n=10 ) and a control group ( n=7 ) . After 12 weeks , the forearm blood flow response to acetylcholine increased significantly , from 25.8+/-9.8 to 32.3+/-11.2 mL. min(-1 ) . 100 mL tissue(-1 ) ( P<0.05 ) , in the exercise group but not in the control group . The increase in the forearm blood flow after isosorbide dinitrate was similar before and after 12 weeks of follow-up in both groups . The infusion of N(G)-monomethyl-L-arginine abolished the exercise-induced enhancement of forearm vasorelaxation evoked by acetylcholine in the exercising group . In normotensive subjects also , long-term aerobic exercise augmented acetylcholine-stimulated nitric oxide release . CONCLUSIONS These findings suggest that long-term physical exercise improves endothelium-dependent vasorelaxation through an increase in the release of nitric oxide in normotensive as well as hypertensive subjects Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed OBJECTIVE To determine the feasibility of conducting a r and omized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage , as well as a nontreatment control group . DESIGN R and omized controlled-comparison trial with 3 parallel groups . SETTING Private practice outpatient chiropractic clinic . PATIENTS Twenty-three subjects , aged 24 to 50 years with systolic or diastolic essential hypertension . INTERVENTIONS Two months of full-spine chiropractic care ( ie , Gonstead ) consisting primarily of specific-contact , short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation . The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation . The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room . MAIN OUTCOME MEASURES Cost per enrolled subject , as well as systolic and diastolic blood pressure ( BP ) measured with a r and om-0 sphygmomanometer and patient reported health status ( SF-36 ) . Pilot study outcome measures also included an assessment of cooperation of subjects to r and omization procedures and drop-out rates , recruitment effectiveness , analysis of temporal stability of BPs at the beginning of care , and the effects of inclusion /exclusion criteria on the subject pool . RESULTS Thirty subjects enrolled , yielding a cost of $ 161 per enrolled subject . One subject was later determined to be ineligible , and 6 others dropped out . In both the chiropractic and massage therapy groups , all subjects were classified as either overweight or obese ; in the control group there were only 2 classified as such . SF-36 profiles for the groups were similar to that of a normal population . The mean change in diastolic BP was -4 ( 95 % confidence interval [ CI ] : -8.6 , 0.5 ) in the chiropractic care group , 0.5 ( 95 % CI : -3.5 , 4.5 ) in the brief massage treatment group , and -4.9 ( 95 % CI : -9.7 , -0.1 ) in the no treatment control group . At the end of the study period , this change was -6.3 ( 95 % CI : 13.1 , 0.4 ) , -1.0 ( 95 % CI : -7.5 , 15.6 ) , -7.2 ( 95 % CI : -13.3 , -1.1 ) in the 3 study groups . The mean improvements in the chiropractic care and no treatment control groups remained consistent over the follow-up period . CONCLUSIONS This pilot study eluci date d several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension . A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control . Measures need to be used to assure comparable groups regarding prognostic variables such as weight . Studies such as these demonstrate the feasibility of conducting a full-scale 3-group r and omized clinical trial in the private practice setting To determine the antihypertensive efficacy of aerobic exercise training in mild essential hypertension , a prospect i ve r and omized controlled trial was conducted comparing an aerobic exercise regimen to a placebo exercise regimen , with a crossover replication of the aerobic regimen in the placebo exercise group . The study took place in an outpatient research clinic in a university-affiliated Veterans Administration medical center . Twenty-seven men with untreated diastolic blood pressure ( DBP ) of 90 - 104 mm Hg were r and omized to the two exercise regimens . Ten patients completed the aerobic regimen .  Nine patients completed the control regimen , seven of whom subsequently entered and completed the aerobic regimen . The aerobic regimen consisted of walking , jogging , stationary bicycling , or any combination of these activities for 30 minutes , four times a week , at 65 - 80 % maximal heart rate . The control regimen consisted of slow calisthenics and stretching for the same duration and frequency but maintaining less than 60 % maximal heart rate . DBP decreased 9.6 + /- 4.7 mm Hg in the aerobic exercise group but increased 0.8 + /- 6.2 mm Hg in the placebo control exercise group ( p = 0.02 ) . Systolic blood pressure ( SBP ) decreased 6.4 + /- 9.1 mm Hg in the aerobic group and increased 0.9 + /- 9.7 mm Hg in the control group ( p = 0.11 ) . Subsequently , seven of the nine controls entered a treatment crossover and completed the aerobic regimen with significant reductions in both DBP ( -6.1 + /- 3.2 mm Hg , p less than 0.01 ) and SBP ( -8.1 + /- 5.7 mm Hg , p less than 0.01 ) . BP changes were not associated with any significant changes in weight , body fat , urinary electrolytes , or resting heart rate . This r and omized controlled trial provides evidence for the independent BP lowering effect of aerobic exercise in unmedicated mildly hypertensive men Dietary intakes of potassium , calcium , and magnesium have each been reported to lower blood pressure , but the extent of blood pressure reduction in epidemiological studies and clinical trials has tended to be small and inconsistent . We hypothesized that combinations of these mineral supplements would lower blood pressure and that the reductions would be greater than that usually reported in studies of each cation alone . One hundred twenty-five patients 82 men and 43 women ) with untreated mild or borderline hypertension were r and omly assigned to daily treatment with one of the following four regimens : 60 mmol potassium and 25 mmol ( 1000 mg ) calcium , 60 mmol potassium and 15 mmol ( 360 mg ) magnesium , calcium and magnesium , or placebo .  St and ardized clinic blood pressure measurements were obtained on 3 days at baseline and after 3 and 6 months of treatment . At baseline , systolic and diastolic blood pressures ( mean + /- SD ) were 139 + /- 12 and 90 + /- 4 mm Hg , respectively , and dietary intakes of potassium , calcium , and magnesium were 77 + /- 32 , 19 + /- 13 , and 12 + /- 52 mmol/d , respectively . The mean differences ( with 95 % confidence intervals ) of the changes in systolic and diastolic blood pressures between the treatment and placebo groups were not significant : -0.7 ( -4.3 to + 2.9 ) and -0.4 ( -2.9 to + 2.1 ) for potassium and calcium , -1.3 ( -4.4 to + 1.8 ) and 0.4 ( -2.5 to + 3.3 ) for potassium and magnesium , and + 2.1 ( -1.8 to + 6.0 ) and + 2.2 ( -1.0 to + 5.4 ) for calcium and magnesium . In conclusion , this trial provides little evidence of an important role of combinations of cation supplements in the treatment of mild or borderline hypertension The main objective of this clinical trial was to evaluate the effects of magnesium pidolate ( 15 mmol/day ) on blood pressure at rest and during sympathetic stimulation induced by cold , isometric and tilt test ; peripheral blood flow has been evaluated by strain-gauge plethysmography . Fourteen mild to moderate hypertensives ( 8 males , 6 females , age range 40 - 60 years ) were r and omly given magnesium or placebo in a double-blind parallel clinical trial for 6 months . In the actively treated group magnesium urinary excretion increased from 5.3 + /- 2 to 7.7 + /- 2 mmol/24 h , and serum magnesium changed from 0.9 + /- 0.1 to 1.0 + /- 0.2 mmol/l . On magnesium , BP changed at rest from 156/97 + /- 12/4 to 149/90 + /- 8/3 mm Hg , during cold pressor test from 169/105 + /- 9/6 to 174/105 + /- 15/4 , during isometric exercise from 170/107 + /- 13/9 to 170/105 + /- 20/6 , and during tilt test from 149/96 + /- 11/6 to 153/96 + /- 17/7 mm Hg . Similar changes were observed in the placebo group . Peripheral resistances were 14.7 + /- 4 and 9.8 + /- 2 PRU before and after magnesium , respectively . These data indicate that long-term magnesium pidolate supplementation does not affect blood pressure at rest and during sympathetic stimulation , despite a slight , nonsignificant reduction in forearm peripheral resistance The Oslo Diet and Exercise Study ( ODES ) is an unmasked r and omized 2 x 2 factorial trial of 1-year duration for each participant . During 1990 - 1991 219 participants ( 198 males and 21 females ) aged 41 - 50 were r and omized into one of four treatment groups ; no treatment ( control ) , dietary changes alone , exercise alone , or a combination of the two treatments . At inclusion , the participants had no overt heart disease  , but they had increased body weight ; slightly increased blood pressure , serum triglycerides , and total cholesterol  , and they had decreased  HDL cholesterol . Further , they were all inactive at leisure time . The primary aim of the trial is to compare the isolated and combined effects of the four treatments on the variables fibrinogen , fibrinolytic capacity , coagulation factor VII , and platelet volume . A series of secondary hypotheses will also be tested , such as the effects on other coagulation and fibrinolytic components and activities ; lipids and lipoproteins ; fatty acids ; glucose and insulin response to a glucose load ; clinical , physiological , and anthropometric variables ; and quality of life . The dietary treatments are adapted according to each participant 's risk profile ( level of total cholesterol , HDL cholesterol , triglycerides , blood pressure , and body weight ) . Fish and fish products are recommended . Special emphasis is put on caloric restriction in those who are overweight and those with elevated blood pressure .  Exercise sessions take place three times a week under the guidance of highly qualified instructors . The aim is to increase peak oxygen uptake through aerobic endurance training . Adherence to the exercise program is monitored closely In 46 elderly ( aged greater than or equal to 60 y ) hypertensive subjects with entry systolic blood pressure ( SBP ) greater than or equal to 160 or diastolic blood pressure ( DBP ) greater than or equal to 90 mm Hg , our specific aim in a r and omized , double-blind , crossover study ( two 8-wk treatment periods separated by a 3-wk washout ) was to compare blood pressure-lowering effects of 9 g fish oil/d [ omega-3 ( n-3 ) fatty acid ] vs 9 g corn oil/d [ omega-6 ( n-6 ) fatty acid ] . After a 4-wk baseline period , 22 subjects were r and omly assigned to receive fish oil and 24 to receive corn oil . For both 8-wk treatments there were no between-group differences in the change in blood pressure . There was a treatment difference for st and ing DBP when baseline values were compared with those after treatment 2 ; DBP decreased by 5.1 mm Hg in the fish-oil group vs 0.72 mm Hg in the corn-oil group ( P = 0.024 ) . Within groups during the first treatment , both fish oil and corn oil lowered all four blood pressure measures ( P less than 0.05 ) ; blood pressures were not further lowered during the second treatment compared with the washout period . There were no significant between-group differences in laboratory safety tests or categorical side effects .  Fish oil lowered triglycerides by 0.47 mmol/L ( P less than 0.001 ) . In elderly subjects , diet plus both omega-3 and omega-6 supplements ( 9 g/d ) safely and effectively lower SBP and DBP In a double-blind controlled trial , 91 middle-aged and elderly women with mild to moderate hypertension who were not on antihypertensive medication were r and omly assigned to treatment with magnesium aspartate-HCl ( 20 mmol Mg/d ) or placebo for 6 mo . Magnesium aspartate-HCl in the given dose was well-tolerated and was not associated with an increased frequency of diarrhea compared with placebo . At the end of the study , systolic blood pressure had fallen by 2.7 mm Hg ( 95 % CI -1.2 , 6.7 ; P = 0.18 ) and diastolic blood pressure by 3.4 mm Hg ( 1.3 , 5.6 ; P = 0.003 ) more in the magnesium group than in the placebo group . Blood pressure response was not associated with baseline magnesium status , as measured by dietary magnesium intake and urinary magnesium excretion . Urinary magnesium excretion in the magnesium group increased by 50 % during the intervention period . No changes were seen in other biochemical indexes , including serum concentrations of total and high-density-lipoprotein cholesterol . The findings suggest that oral supplementation with magnesium aspartate-HCl may lower blood pressure in subjects with mild to moderate hypertension Tests of behavioral interventions seldom examine changes in health beliefs and behaviors thought to be prerequisites of improved outcome health states and they do not attempt to specify how patient characteristics or pretest measures influence responses to the intervention . In this study an experimental nursing intervention , its impact on hypertensive patients ' beliefs about their disease , efficacy of medications and diet , as well as blood pressure and weight are described . Among patients from the experimental group , the ability of selected pretest variables to predict clinical outcomes and changes in clinical health states was evaluated . The intervention was successful in lowering diastolic blood pressure and altering certain beliefs held by the patients . The pretest characteristics were not successful in explaining hypertensive patients ' responses to the intervention . Explanations for this are pursued through remarks from the content analysis of the intervention protocol . From these observations , the original health belief model was revised . The discussion concludes with a set of research questions that may prove promising for future research Epidemiological and experimental data suggest blood pressure-lowering effects of dietary potassium . A r and omized , double-blind clinical trial was used to assess blood pressure response to orally administered potassium , 120 mEq/day , and to placebo in 101 adults with mild hypertension .  Blood pressure was measured with a r and om-zero sphygmomanometer every 2 weeks of this 8-week trial . Systolic blood pressure in the potassium-treated group decreased by 6.4 + /- 13.7 ( SD ) mm Hg ( p less than or equal to 0.025 ) compared with 0.11 + /- 13.0 mm Hg in the placebo-treated group ( p = 0.96 ) . Diastolic blood pressure in the potassium-treated group decreased by 4.1 + /- 8.3 mm Hg ( p less than or equal to 0.05 ) compared with a 1.6 + /- 6.5 mm Hg decrease in placebo-treated subjects ( p = 0.09 ) . Baseline blood pressure of potassium-treated subjects was unexpectedly higher than that of controls . After correcting for baseline variation , blood pressure still decreased 3.4/1.8 mm Hg more in potassium recipients than in placebo recipients ( p = 0.14 and 0.24 , respectively ) . Blood pressure decreased by 19/13 mm Hg in five blacks taking potassium versus a 1/0 mm Hg increase in seven blacks taking placebo .  Compliance with the potassium regimen was 91.5 % by pill count ; only one subject discontinued treatment because of side effects . In conclusion , 120 mEq/day of microencapsulated potassium chloride was well tolerated in adults with mild hypertension . An antihypertensive effect of potassium can not be ruled out despite the fact that there was no statistically significant difference between potassium-treated and placebo-treated subjects after adjustment for differences in baseline blood pressure . ( ABSTRACT TRUNCATED AT 250 WORDS We compared the effects of nonpharmacologic therapy , propranolol monotherapy , and placebo on blood pressure , metabolic , exercise , and quality of life variables in a 12-week , r and omized , placebo-controlled trial of 79 male patients with hypertension . A significant reduction in diastolic blood pressure was observed with both nondrug therapy ( -8.0 + /- 1.08 mm Hg ) and propranolol ( -9.5 + /- 1.46 mm Hg ) compared to placebo ( -0.1 + /- 2.01 mm Hg ) . However , only patients receiving nonpharmacologic therapy showed a reduced body mass index , lower total and low-density lipoprotein serum cholesterol levels , and increased exercise tolerance compared to both propranolol and placebo . Patients receiving propranolol felt less anxious and unsure but showed a significant decrement in nocturnal penile tumescence compared to both placebo and nondrug therapy . Patients receiving nondrug therapy felt more energetic and reported improved sexual arousal and greater sexual satisfaction after treatment . Reductions in blood pressure in the nondrug treatment group were related to both weight reduction and improved fitness . We conclude that nondrug therapy is effective in controlling blood pressure in men with mild hypertension and is associated with improvements in weight , lipoprotein levels , and exercise tolerance compared to both propranolol and placebo .  Quality of life assessment s further support the use of nondrug therapy in this context STUDY OBJECTIVE : To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions : overweight , hypertension and type 2 diabetes . DESIGN : The study was design ed as a r and om controlled trial . Consecutive patients were screened opportunistically for one or more of the above conditions and r and omly allocated to one of two intervention groups ( doctor/dietitian or dietitian ) or a control group . Both intervention groups received six counselling sessions over 12 months from a dietitian . However , in the doctor/dietitian group it was the doctor and not the dietitian who invited the patient to join the study and the same doctor also review ed progress at two of the six counselling sessions . SETTING : The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth , Western Australia . PATIENTS : Of the 273 patients r and omly allocated to a study group , 198 were women . Age ranged from 25 to 65 years . Seventy eight per cent of patients resided in the lower two socioecnomic quartiles , 56 per cent described their occupation as home duties and 78 per cent were partnered . RESULTS : Both intervention groups reduced weight and blood pressure compared with the control group . Patients in the doctor/dietitian group were more likely to complete the 12 month programme than those in the dietitian group . Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $ A9.76 per kilogram , while the dietitian group lost 5.6 kg at a cost of $ A7.30 per kilogram . CONCLUSION : General practitioners , in conjunction with a dietitian , can produce significant weight and blood pressure improvement by health promotion methods A r and omized , double-blind , placebo-controlled crossover trial of oral calcium supplementation was carried out in 18 patients with uncomplicated essential hypertension . After 15 weeks of oral calcium supplementation , 1 g/day , of the patients ' habitual diet , the only blood pressure change ( compared with the results of placebo treatment ) was in the average st and ing systolic blood pressure , which was significantly reduced ( -8.6 mm Hg ; p less than 0.01 ) . The 24-hour urinary calcium excretion and the total serum calcium concentration increased significantly during calcium supplementation ( p less than 0.05 ) , indicating good compliance with the treatment . The individual blood pressure changes with high calcium intake were found to be inversely related to basal 24-hour urinary calcium excretion ( r = -0.69 , p less than 0.001 for st and ing systolic pressure ; r = -0.55 , p less than 0.002 for st and ing diastolic pressure ) . This correlation was independent of age , basal blood pressure , serum calcium concentration , basal 24-hour urinary sodium excretion , and body weight changes during the trial . In particular , a subgroup of six patients , who had a basal 24-hour urinary calcium excretion higher than the mean + 2 SD of a reference healthy population previously described , showed a substantial average blood pressure fall at variance with the other patients in the study . These results do not support the usefulness of an oral calcium supplement in the majority of subjects with mild essential hypertension ; however , they suggest that a group of patients with a previously reported abnormality of calcium metabolism may be responsive to this therapeutic measure BACKGROUND Although nonpharmacologic interventions are widely recommended in the therapy of high blood pressure in older adults , surprisingly little data exist to confirm the efficacy of these interventions in older persons . METHODS We conducted a r and omized , controlled clinical trial in persons aged 60 to 85 years with a diastolic blood pressure of 85 to 100 mm Hg . The experimental arm was a nonpharmacologic intervention combining weight reduction , sodium restriction , and increased physical activity . The nonpharmacologic intervention consisted of eight weekly group and two individual sessions during the intensive phase , followed by four monthly group sessions during the maintenance phase . The control group received no treatment during the study .  Blood pressure was assessed by certified technicians ( blinded to group assignment ) using r and om zero sphygmomanometers . RESULTS Of 56 participants r and omized , 47 completed the entire 6-month trial ( 21 in the intervention group and 26 in the control group ) . Attendance at the intervention sessions was excellent . The intervention group lost more weight ( -2.1 kg ) over 6 months than the control group ( + 0.3 kg ) . Trends for decreasing 24-hour urine sodium excretion in both the intervention and control groups , with greater trend in the intervention group , were not statistically significant . The intervention group experienced more reduction in systolic and diastolic blood pressure than did the control group ( mean differences between groups at 6 months , 4.2/4.9 mm Hg , respectively ) . CONCLUSIONS Our data indicate that a nonpharmacologic intervention will lower systolic and diastolic blood pressure levels in older people with borderline or mild elevations of diastolic blood pressure Obesity , especially central , increases the risk of hypertension , hypertriglyceridaemia and diabetes to a significant extent . To determine whether dietary weight reduction can reduce blood pressure ( BP ) and other cardiovascular risk factors , 217 hypertensives were r and omised to receive either 1600 Kcal/day diet ( group A , n = 108 ) or the usual 2100 Kcal/day diet ( group B , n = 109 ) . Sodium intake and physical activity were kept similar in both groups . After 16 weeks of follow-up , patients in group A received significantly less energy leading to a 2.8 kg net reduction in mean weight in association with a significant net decrease in mean SBP and DBP ( 7.5/6.5 mm Hg ) compared with nonsignificant changes in group B. There was a significant net decrease in mean total cholesterol ( 7.0 % ) , low-density lipoprotein (LDL)-cholesterol ( 7.9 % ) and triglycerides ( 8.0 % ) , with a significant net increase in high-density lipoprotein (HDL)-cholesterol ( 4.0 % ) in group A compared with group B. New risk factors such as glucose intolerance ( 8.0 % ) and central obesity ( waist-hip girth ratio , 0.021 ) showed a significant net reduction compared with group B. Patients with central obesity and other associated disturbances showed maximal reduction in BP and other cardiovascular risk factors with a significantly greater increase in HDL-cholesterol . Mean doses of drugs were similar at entry to the study as well as after 16 weeks in both groups . It is possible that weight reduction due to a low caloric diet can moderate central obesity and associated disturbances in hypertensive subjects A group of previously untreated obese hypertensive patients were started on a weight reduction programme supervised by two dietitians working in a general practice surgery . It was stressed from the beginning of the programme that reducing blood pressure was the purpose of the diet . The results of follow-up after six months are presented together with results for a control group of obese hypertensive patients not receiving dietary advice or drug therapy , but being followed by the general practitioner . The weight , systolic blood pressure and diastolic blood pressure of the dieting hypertensive group were significantly lower than those of the non-dieting group after six months . However , the drop-out rate was significantly higher for the dieting group than for the non-dieting group . The results of a separate comparison between a control group of obese normotensive patients following the same dietary programme and the group of dieting obese hypertensive patients are also presented . Attendance rates and weight loss achieved were significantly better for the hypertensive group than for the normotensive group after 12 months . Weight reduction appears to be an effective first-line therapy for approximately 50 % of obese patients with mild to moderate hypertension , and raised blood pressure appears to provide motivation for such patients to attend a dietitian 's clinic and to lose weight The contribution of training procedures design ed to alter individuals ' psychological responses to stressful life stimuli to the reduction of blood-pressure levels of hypertensives was evaluated . The treatment consisted of a set of coping skill-building experiences .  Forty-one black males , mildly to moderately hypertensive and under medical supervision in an outpatient cardiovascular unit of a veterans ' hospital , participated . Subjects were r and omly assigned to one of three groups : Cognitive Self-Management Training ( CSM ) , Attention Placebo Control , and Current Clinic Conditions Control . The dependent measures were the State Anxiety Scale , Trait Anxiety Scale , Coping Strategic Inventory , systolic blood pressure , and diastolic blood pressure . Subjects in the CSM group reported significant increases in the use of cognitive coping strategies in their lives and demonstrated significant decreases in measured levels of state anxiety and systolic blood pressure . Promising reductions of diastolic blood pressure ratings were obtained as well Fish and fish oils have been reported to reduce blood pressure in normotensives and untreated hypertensives . The present study examined the effect of dietary supplementation with fish oil on blood pressure in 20 treated hypertensives with controlled blood pressures who continued their usual antihypertensive drug treatment throughout . A double-blind , r and omized crossover design was used , with two phases , each of 8 weeks ' duration . In one phase , subjects took fifteen 1 g fish oil capsules ( Lipitac ; Reckitt and Colman Pharmaceuticals , Sydney , Australia ) daily , and in the other , 15 capsules of identical appearance containing 1 g olive oil daily . There was no difference between the treatment phases for any blood pressure parameter , heart rate or body weight , but blood pressure was lower in both phases compared with pretreatment values . The fasting plasma triglyceride concentration was 30 % lower in the fish oil phase ( P less than 0.001 ) , but there was no difference between the phases for plasma concentrations of total or high-density lipoprotein ( HDL ) cholesterol . We conclude that , in treated hypertensives with controlled blood pressures , any additional fall in blood pressure produced by dietary supplementation with fish oil is so small that the requirement for antihypertensive drug therapy is unlikely to be reduced In order to assess the effects of a Behavioral Treatment Program in the control of primary hypertension , twenty one unmedicated hypertensives were r and omly allocated to three groups : first , a treatment group ( BHG ) receiving a Behavioral Treatment which included : deep muscle relaxation , peripheral temperature Biofeedback and anxiety management training ; second , the placebo attention control group ( PHG ) and third , a control group of hypertensives too ( CHG ) . Additionally , were compared with seven normotensives subjects ( CNG ) . The post-treatment measures showed a significant reduction ( p < 0.001 ) in systolic and diastolic values only in the ( BHG ) . In a six months follow-up the ( BHG ) group still showed a significant reduction in the systolic and diastolic BP ( p < 0.02 ; p < 0.01 ) . Moreover individual variations in response to treatment were observed in this group , ( BHG ) This study examined the effect of a relaxation technique on plasma lipids , weight , blood pressure , and blood glucose .  Sixteen outpatient males were r and omly assigned to control or experimental groups . The experimental group was taught a relaxation technique that they used throughout the study . The control group was started in a reading program . Subjects were followed by a nurse practitioner and dietitian for eight weeks . Results revealed a significant reduction in systolic blood pressure and a marginally significant reduction in low density lipoprotein ( LDL ) cholesterol in the experimental group . Both control and experimental groups self-reported high compliance with diet and adherence to prescribed intervention . State anxiety was found to be inversely related to changes in total cholesterol and LDL cholesterol Forty-seven patients with mild hypertension and 48 normotensive patients entered a blinded , parallel study in which they received a placebo , 10 mmol/day calcium carbonate ( CaCO3 ) , or 20 mmol/day CaCO3 . There were no significant differences in blood pressure changes among the groups . In the hypertensive group and in patients with the highest blood pressure there were individual falls in systolic pressure , particularly in the group receiving 10 mmol daily CaCO3 . In the hypertensive group the changes were : with placebo , −3±2/− 2±2 mm Hg ; with CaCO3 ( 10 mmol ) , −7±3/− 2±2 mm Hg ; and with CaCO3 ( 20 mmol ) , −2±3/l±2 mm Hg . No change was significant , and no pressure changes of patients taking CaCO3 differed significantly from changes of patients taking placebo . Ten of 33 patients taking placebo , 11 of 31 taking 10 mmol/ day CaCO3 , and nine of 31 taking 20 mmol/day CaCO3 were classified as responders from their systolic blood pressure fall . These response rates did not differ . Eight patients had falls of systolic blood pressure greater than 15 mm Hg . Five were on 10 mmol/day CaCO3 and three on 20 mmol/day CaCO3 . This response was significantly different from that with placebo . Univariate analyses failed to reveal any predictive dietary or biochemical parameter . After 3 months of not taking CaCO3 , 12 patients classified as responders , including six of the eight with a fall of 15 mm Hg or more , were rer and omized to placebo or to 20 mmol/day CaCO3 . In the rechallenge , responses to CaCO3 and placebo were similar , neither causing a significant pressure fall . Calcium carbonate did not reduce blood pressure . The apparent response hi a few patients was not verified by rechallenge . The present study does not support calcium supplementation as a useful nonpharmacological measure for reducing elevated blood pressure The aim of the study was to clarify the feasibility of physical training for middle-aged borderline-hypertensive males . Blood pressure of 59 subjects was followed for nine months , whereafter 25 persons were classified as borderline-hypertensive and 34 persons as normotensive . Both groups were r and omly allocated into training and control groups . Training lasted for four months , of which the first two included supervised bicycle ergometer exercise . During the last two months training was unsupervised . After training estimated maximal oxygen consumption increased significantly both in borderline-hypertensive and normotensive men . After training resting diastolic blood pressure decreased significantly both in training and control groups . This finding supports the importance of sufficiently long follow-up of blood pressure before eventual drug therapy when blood pressure is mildly elevated . Diastolic blood pressure during 50-minute ergometer exercise was decreased after four months of training in borderline-hypertensives and did not any longer differ from that of normotensives . Individually prescribed physical training is worth regarding as one treatment modality for middle-aged borderline-hypertensive patients The effects of long-term sodium restriction on plasma atrial natriuretic factor ( ANF ) concentrations , and the role of baseline plasma ANF concentration as an indicator of changes in haemodynamics and left ventricular hypertrophy during this treatment were studied in 40 middle-aged previously untreated mildly to moderately hypertensive men and women in a 6-month controlled r and omized study . The main emphasis of the treatment programme was to reduce daily sodium intake to less than 70 mmol . Mean sodium excretion decreased from 148 + /- 74 mmol 24 h-1 to 79 + /- 71 mmol 24 h-1 in the treatment group , but remained unchanged in the control group ( 173 + /- 68 mmol 24 h-1 vs. 186 + /- 62 mmol 24 h-1 ; P less than 0.01 for the difference in changes between the groups ) . Mean plasma ANF concentrations in the treatment group were 52.4 + /- 20.7 ( median 50 ) pg ml-1 at baseline and 38.7 + /- 26.3 ( median 42 ) pg ml-1 at 6 months , and the corresponding values in the control group were 55.5 + /- 20.5 ( median 50 ) pg ml-1 and 46.1 + /- 32.4 ( median 50 ) pg ml-1 , respectively ( P = NS for the difference in changes ) . The ANF concentration decreased from 70 + /- 14 pg ml-1 to 32 + /- 26 pg ml-1 in treated subjects with a high baseline plasma ANF concentration ( greater than 50 pg ml-1 ) , but increased from 37 + /- 11 pg ml-1 to 45 + /- 27 pg ml-1 in subjects with a low baseline plasma ANF concentration ( less than or equal to 50 pg ml-1 ) ( difference in changes P less than 0.001 ) . Compared with treated subjects with low baseline plasma ANF levels and with controls , treated subjects with high baseline plasma ANF levels showed a decrease ( P less than 0.05 ) in interventricular septal and left posterior wall thicknesses , in relative wall thickness , and in peripheral resistance . These results suggest that in mildly to moderately hypertensive subjects long-term sodium restriction decreases high plasma ANF concentrations concomitantly with regression of concentric left ventricular hypertrophy , probably as a result of changes in haemodynamics Objective : To examine the efficacy of a new device , which slows and regularises breathing , as a non-pharmacological treatment of hypertension and thus to evaluate the contribution of breathing modulation in the blood pressure ( BP ) reduction . Design and setting : R and omised , double-blind controlled study , carried out in three urban family practice clinics in Israel . Patients : Sixty-five male and female hypertensives , either receiving antihypertensive drug therapy or unmedicated . Four patients dropped out at the beginning of the study .Intervention : Self treatment at home , 10 minutes daily for 8 consecutive weeks , using either the device ( n = 32 ) , which guides the user towards slow and regular breathing using musical sound patterns , or a Walkman , with which patients listened to quiet music ( n = 29 ) . Medication was unchanged 2 months prior to and during the study period . Main outcome measures : Systolic BP , diastolic BP and mean arterial pressure ( MAP ) changes from baseline . Results : BP reduction in the device group was significantly greater than a predetermined ‘ clinical ly meaningful threshold ’ of 10.0 , 5.0 and 6.7 mm Hg for the systolic BP , diastolic BP and MAP respectively ( P = 0.035 , P = 0.0002 and P = 0.001 ) . Treatment with the device reduced systolic BP , diastolic BP and MAP by 15.2 , 10.0 and 11.7 mm Hg respectively , as compared to 11.3 , 5.6 and 7.5 mm Hg ( P = 0.14 , P = 0.008 , P = 0.03 ) with the Walkman . Six months after treatment had stopped , diastolic BP reduction in the device group remained greater than the ‘ threshold ’ ( P < 0.02 ) and also greater than in the walkman group ( P = 0.001 ) . Conclusions : The device was found to be efficacious in reducing high BP during 2 months of self-treatment by patients at home . Breathing pattern modification appears to be an important component in this reduction After a general clinical observation period of over 4 weeks , 20 essential hypertensive subjects ( Japanese ) were r and omly divided into two groups . One group ( n = 10 ; 4 men and 6 women ; 51.4 + /- 2.8 years of age ) agreed to physical training using bicycle ergometer exercise with the intensity at blood lactate threshold for 60 minutes three times a week for 10 weeks , while the other group ( n = 10 ; 4 men and 6 women ; 51.0 + /- 2.9 years of age ) did no particular physical training and was followed once a week as the control . Changes in blood pressure , hemodynamics , and humoral factors of the exercised group were compared with values in the controls . The following significant changes were found only in the exercised group . Blood pressure was significantly ( p less than 0.01 ) reduced . Whole blood and plasma volume indices were significantly reduced ( p less than 0.05 , p less than 0.01 , respectively ) . The change in ratio of serum sodium to potassium positively correlated with the change in systolic blood pressure ( r = 0.76 , p less than 0.02 ) . Plasma norepinephrine concentrations both at rest and at the workload of blood lactate threshold during grade d exercise tests were significantly reduced ( p less than 0.05 , p less than 0.02 respectively ) after 10 weeks of exercise training . The change in the resting level of plasma norepinephrine positively correlated with that in the mean blood pressure . No such changes were observed in the control group . In both groups , body weight and urinary sodium excretion showed no statistically significant changes . ( ABSTRACT TRUNCATED AT 250 WORDS The aim of this study was to evaluate if a nutritional dose of magnesium given orally changes the blood pressure in untreated hypertensive patients and if orally-given magnesium had any influence on serum and muscle magnesium and potassium . A r and omized , double-blind crossover study design was followed with magnesium 15 mmol/day or placebo treatment for two months . Thirty-nine patients aged 20 - 59 years , were treated . Sample s for magnesium and potassium in blood , muscle and urine were taken at entry time , after two months ( crossover time ) and after four months ( end of study ) . Systolic and diastolic supine and st and ing blood pressures were measured at the same times . No significant change in blood pressure , serum or muscle concentrations of electrolytes were observed on magnesium treatment . Urine magnesium rose significantly on magnesium , and it decreased significantly on placebo . Therefore results suggest that 15 mmol magnesium/day , given to untreated mild-to-moderate hypertensives does not alter blood pressure nor the concentrations of magnesium and potassium in serum and muscle , in patients with normal magnesium turnover To determine the impact of dietary patterns on the control of hypertension we studied the subgroup of 133 participants with systolic blood pressure ( BP ) of 140 to 159 mm Hg and /or diastolic BP of 90 to 95 mm Hg enrolled in the Dietary Approaches to Stop Hypertension ( DASH ) study . Participants were fed a control diet for a 3-week period and were then r and omized to receive for 8 weeks either the control diet ; a diet rich in fruits and vegetables , but otherwise similar to control ; or a combination diet rich in fruits , vegetables , and low-fat dairy products , including whole grains , fish , poultry , and nuts , and reduced in fats , red meats , sweets , and sugar-containing beverages .  Sodium intake and body weight were held constant throughout the study . The combination diet significantly reduced systolic BP ( -11.4 mm Hg , P < .001 ) and diastolic BP ( -5.5 mm Hg , P < .001 ) . The fruits- and -vegetables diet also significantly reduced systolic BP ( -7.2 mm Hg , P < .001 ) and diastolic BP ( -2.8 mm Hg , P = .013 ) . The combination diet produced significantly greater BP effects ( P < .05 ) than the fruits- and -vegetables diet .  Blood pressure changes were evident within 2 weeks of starting the intervention feeding . After the 8-week intervention period , 70 % of participants eating the combination diet had a normal BP ( systolic BP < 140 and diastolic BP < 90 mm Hg ) compared with 45 % on the fruits- and -vegetables diet and 23 % on the control diet . In patients with hypertension , the DASH combination diet effectively lowers BP and may be useful in achieving control of Stage 1 hypertension This pilot study was aim ed at investigating the hypotensive potential of hawthorn extract and magnesium dietary supplements individually and in combination , compared with a placebo .  Thirty-six mildly hypertensive subjects completed the study . At baseline , anthropometric and dietary assessment , as well as blood pressure measurements were taken at rest , after exercise and after a computer ' stress ' test . Volunteers were then r and omly assigned to a daily supplement for 10 weeks of either : ( a ) 600 mg Mg , ( b ) 500 mg hawthorn extract , ( c ) a combination of ( a ) and ( b ) , ( d ) placebo . Measurements were repeated at 5 and 10 weeks of intervention . There was a decline in both systolic and diastolic blood pressure in all treatment groups , including placebo , but ANOVA provided no evidence of difference between treatments . However , factorial contrast analysis in ANOVA showed a promising reduction ( p = 0.081 ) in the resting diastolic blood pressure at week 10 in the 19 subjects who were assigned to the hawthorn extract , compared with the other groups . Furthermore , a trend towards a reduction in anxiety ( p = 0.094 ) was also observed in those taking hawthorn compared with the other groups . These findings warrant further study , particularly in view of the low dose of hawthorn extract used A 5-year trial involving 201 men and women with high-normal blood pressure at baseline demonstrated the ability to reduce the incidence of hypertension in participants r and omized to nutritional-hygienic intervention compared with a control group . The incidence of hypertension was 8.8 % among 102 intervention group participants vs 19.2 % among 99 control group members . The odds ratio for the incidence of hypertension in the control group was 2.4 . Mean trial blood pressure also was lower in the intervention compared with the control group ( -1.2 and -1.9 mm Hg , respectively , for diastolic blood pressure at work-site and office visits and -1.3 and -2.0 mm Hg , respectively , for systolic blood pressure at the two sites ) . Net weight loss in the intervention group averaged 2.7 kg during the trial ; sodium intake was reduced by 25 % and reported alcohol intake decreased by 30 % . The majority of intervention participants also reported an increase in physical activity . Effect on blood pressure was related particularly to degree of weight loss . Results indicate that even a moderate reduction in risk factors for hypertension among hypertension-prone individuals contributes to the primary prevention of the disease OBJECTIVE --To assess the effects of physical exercise training on blood pressure in patients with mild hypertension . DESIGN --R and omized controlled trial . SETTING --Hospital-based cardiac rehabilitation program . PATIENTS --Ninety-nine men and women with untreated mild hypertension ( systolic blood pressure , 140 to 180 mm Hg ; diastolic blood pressure , 90 to 105 mm Hg ) were included in the volunteer sample . INTERVENTIONS --Subjects were r and omly assigned to a 4-month program of aerobic exercise training , strength and flexibility training , or to a waiting list control group . MAIN OUTCOME MEASURES --The main outcome measures were systolic and diastolic blood pressures measured four times with a r and om zero sphygmomanometer on 3 separate days in a clinic setting . RESULTS --After 4 months of exercise training , subjects in the aerobic exercise group did not exhibit greater reductions in blood pressure than subjects in the control group . We expected a differential decline of 5 mm Hg between the aerobic exercise and waiting list control groups and found a difference of -1.0 + /- 16 mm Hg and -1.2 + /- 10 mm Hg at alpha = .05 for systolic and diastolic blood pressure , respectively . CONCLUSIONS --Moderate aerobic exercise alone should not be considered a replacement for pharmacologic therapy in nonobese patients with mild hypertension 28 patients who had a sustained diastolic blood pressure of 95 to 104 mm Hg and who had no treatment for it for at least 13 months before the trial , but who were otherwise unselected , took part in a r and omised controlled trial in which the effect of a restricted sodium diet was compared with that of a general health package . The general health package did not include any specific hypotensive procedures . Changes in blood pressure were measured at predetermined intervals over the course of a year . Within each group both systolic and diastolic blood pressure fell to a highly significant extent after a year , but there was no significant difference between the groups . It would thus seem that the antihypertensive effect of a restricted sodium diet may be related to the increased consultation and monitoring activity of such intervention rather than to the dietary manipulation itself & NA ; We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication . The effect was assessed in multiple setting s , including the relaxation therapist 's office , the Hypertension Clinic , and the patient 's natural environment , the latter using 24‐hour automated ambulatory blood pressure measures . Nineteen patients were r and omized  either to temperature biofeedback‐assisted relaxation or to an attention control , “ stress education . ” Antihypertensive medication was kept constant . In the behavioral therapist 's office , blood pressure decreased in equivalent amounts with both treatments . Hypertension Clinic nurse blood pressure remained stable or increased with both treatments , but again there was no difference between treatments . Ambulatory blood pressure increased with relaxation therapy and decreased with stress education , the effect being significant for diastolic pressure . The effects on ambulatory blood pressure were limited to the waking hours . The only variable that showed superior effects for relaxation therapy was physician‐determined blood pressure . These results call into question the generalizability of the effects of relaxation therapy from one setting to another OBJECTIVE To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure , and whether reduction of alcohol intake can be maintained for 2 years . DESIGN A r and omized controlled trial . METHODS Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were r and omly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months . The goal of the intervention was the lower of 2 or fewer drinks daily or a 50 % reduction in intake . A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg , or 80 to 99 mm Hg if recently taking medication for hypertension . RESULTS Reduction in average weekly self-reported alcohol intake was significantly greater ( P<.001 ) at every assessment from 3 to 24 months in the intervention group vs the control group : levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months , with similar reductions after 24 months . The intervention group had a 1.2/0.7-mm Hg greater reduction in blood pressure than the control group ( for each , P = .17 and P = .18 ) for the 6-month primary end point ; for the hypertensive stratum the difference was 0.9/0.7 mm Hg ( for each , P = .58 and P = .44 ) . CONCLUSIONS The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure . The results from the Prevention and Treatment of Hypertension Study ( PATHS ) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension National guidelines for the prevention and treatment of hypertension recommend sodium reduction , weight loss , the Dietary Approach to Stop Hypertension ( DASH ) diet , and regular aerobic exercise . However , no trial has assessed the efficacy of simultaneously implementing all of these recommendations . The objective of this study was to determine the effects on blood pressure and other cardiovascular disease risk factors of a comprehensive lifestyle intervention . We conducted a r and omized controlled trial of 44 hypertensive , overweight adults on a single blood pressure medication . Participants were r and omized to a lifestyle or control group . For 9 weeks , the lifestyle group was fed a hypocaloric version of the DASH diet that provided 100 mmol/d of sodium . This group also participated in a supervised , moderate-intensity exercise program 3 times per week . The control group received no intervention . Outcomes were ambulatory blood pressure , serum lipids , weight , and fitness . At the end of the intervention , mean weight loss in the lifestyle group , net of control , was 4.9 kilograms . In the lifestyle group mean net reductions in 24-hour ambulatory systolic and diastolic blood pressures were 9.5 mm Hg ( P<0.001 ) and 5.3 mm Hg ( P<0.002 ) , respectively . Corresponding changes in daytime systolic and diastolic blood pressures were 12.1 mm Hg ( P<0.001 ) and 6.6 mm Hg ( P<0.001 ) . The lifestyle group experienced mean reductions in total cholesterol ( -25 mg/dL , P<0.001 ) , low-density lipoprotein cholesterol ( -18 mg/dL , P=0.005 ) , high-density lipoprotein cholesterol ( -5 mg/dL , P<0.001 ) , net of control . In conclusion , among hypertensive overweight adults already on antihypertensive medication , a comprehensive lifestyle intervention can substantially lower blood pressure and improve blood pressure control A 15 week r and omised double blind placebo controlled trial of oral potassium supplements ( 48 mmol daily ) was conducted in 37 patients who had mildly increased blood pressure and a normal dietary intake of sodium . After a two month run in and a one week baseline period the patients were r and omly assigned to receive either potassium supplements ( n = 18 ) or placebo ( n = 19 ) . By the third week of treatment blood pressure in the actively treated group had decreased significantly compared with that in the placebo group , though the decrease reached its maximum after 15 weeks . Urinary potassium excretion increased significantly in the group who received potassium supplements , but no significant changes were found in plasma sodium and potassium concentrations or in urinary sodium excretion . In a subgroup of 13 patients who underwent a further nine weeks of treatment with oral potassium supplements at half of the previous dose ( 24 mmol daily ) their blood pressure , at the end of this second study period , was still significantly lower compared with their baseline value but not with that of the placebo group . These results show that moderate oral potassium supplements are associated with a long term reduction in blood pressure in patients who have mild hypertension We evaluated the effect of oral calcium supplementation on blood pressure , calcium metabolism , and insulin resistance in essential hypertension . After receiving a st and ard diet with 500 mg of calcium per day during a 4-week period , 20 nondiabetic , essential hypertensive patients were r and omized in a double-blind fashion to receive oral calcium supplementation ( 1500 mg of calcium per day ) or placebo for 8 weeks . At the end of the 4-week period of low-calcium diet and after the 8-week period of intervention , we measured blood pressure ( by both office and 24-hour ambulatory blood pressure monitoring ) , calcium-regulating hormones [ urinary hydroxyproline and serum osteocalcin , parathormone , and 1,25(OH)2-vitamin D3 ] , intraplatelet free calcium concentration , fasting plasma glucose and insulin levels , and the insulin-sensitivity index ( euglycemic-hyperinsulinemic clamp ) . Compared with patients maintained at low calcium intake , essential hypertensive patients under oral calcium supplementation significantly reduced serum osteocalcin ( from 22.2 + /- 1.9 to 17.9 + /- 2.0 micrograms/L ; P = .0015 ) , parathormone ( from 4.20 + /- 0.38 to 3.30 + /- 0.36 pmol/L ; P = .0003 ) , and 1,25(OH)2-vitamin D3 ( from 98.0 + /- 11.0 to 61.6 + /- 5.7 pmol/L ; P = .0062 ) . Likewise , we found a significant reduction in intraplatelet free calcium concentration ( from 35.9 + /- 1.2 to 26.5 + /- 0.8 nmol/L ; P = .0005 ) and fasting plasma insulin levels ( from 71.8 + /- 5.9 to 64.6 + /- 6.2 pmol/L ; P = .05 ) and a significant increase in the insulin-sensitivity index ( from 2.89 + /- 0.77 to 4.00 + /- 0.95 mg.kg-1.min-1 ; P = .0007 ) . None of these parameters were significantly modified in patients maintained at low calcium intake . Office and 24-hour mean values of systolic and diastolic blood pressure did not change after 8 weeks of oral calcium supplementation or placebo The relation between alcohol consumption and blood pressure is well recognized , and advice to reduce alcohol plays an important part in the management of hypertensive patients . We have evaluated the effectiveness of this advice in a r and omized , controlled , single-blind clinical study . After a 2-week run-in period , hypertensive men regularly consuming more than 20 units/wk ( 1 unit = 10 g ) of alcohol  were r and omly assigned either to the " advice " or control group and were seen at 2-week intervals over an 8-week study period . The outcome measures were : reported alcohol consumption ( 1-week retrospective diary ) , markers of alcohol consumption ( serum gamma-glutamyl transpeptidase , aspartate aminotransferase , uric acid , mean corpuscular volume ) , and blood pressure ( sitting and st and ing ) . Over 18 months , 67 men who drank more than 20 units/wk of alcohol were seen . Twenty-six either were excluded , refused to participate , or dropped out due to nonattendance . Forty-one patients completed the study . After intervention , reported alcohol consumption fell from 60 units/wk to around 30 units/wk in the advice group , whereas it remained between 50 and 60 units/wk in the control group ( analysis of variance [ ANOVA ] F = 7.1 , p less than 0.05 ) . This was accompanied by falls in gamma-glutamyl transpeptidase ( 20.9 % ) and aspartate aminotransferase ( 18.1 % ) , but no significant changes were seen in the control group . St and ing diastolic blood pressure fell significantly in the advice group ( from 101.5 mm Hg to 96.3 mm Hg ) compared with the control group ( ANOVA F = 4.8 , p less than 0.05 ) . The results suggest that advice to reduce alcohol consumption is a useful form of treatment for hypertensive patients who drink excessively An increase in magnesium intake has been suggested to lower blood pressure ( BP ) . However , the results of clinical studies are inconsistent . We studied the effects of magnesium supplementation on office , home , and ambulatory BPs in patients with essential hypertension . Sixty untreated or treated patients ( 34 men and 26 women , aged 33 to 74 years ) with office BP > 140/90 mm Hg were assigned to an 8-week magnesium supplementation period or an 8-week control period in a r and omized crossover design . The subjects were given 20 mmol/d magnesium in the form of magnesium oxide during the intervention period . In the control period , office , home , and average 24-hour BPs ( mean+/-SE ) were 148.6+/-1.6/90.0+/-0.9 , 136.4+/-1.3/86.8+/-0.9 , and 133.7+/-1.3/81.0+/-0.8 mmHg , respectively . All of these BPs were significantly lower in the magnesium supplementation period than in the control period , although the differences were small ( office , 3.7+/-1.3/1.7+/-0.7 mmHg ; home , 2.0+/-0.8/1.4+/-0.6 mmHg ; 24-hour , 2.5+/-1.0/1.4+/-0.6 mm Hg ) . Serum concentration and urinary excretion of magnesium increased significantly with magnesium supplementation . Changes in 24-hour systolic and diastolic BPs were correlated negatively with baseline BP or changes in serum magnesium concentration . These results indicate that magnesium supplementation lowers BP in hypertensive subjects and this effect is greater in subjects with higher BP . Our study supports the usefulness of increasing magnesium intake as a lifestyle modification in the management of hypertension , although its antihypertensive effect may be small Forty-eight black patients with mildly increased blood pressure ( BP ) that had not yet been subjected to treatment took part in a double-blind clinical trial of the efficacy and tolerability of oral potassium supplements ( 64 mmol daily ) versus a matching placebo ( made of starch with coating ) in a 16-week study . Potassium supplements produced a significant decrease in mean supine and st and ing BP within 4 weeks after treatment inception . Urinary potassium excretion increased significantly in the 24 patients who received potassium supplements ( p < 0.001 ) . No significant changes occurred in plasma sodium and potassium concentrations or in urinary excretion of sodium during the study .  All patients completed the trial without experiencing any notable untoward effects . These results are consistent with the premise that oral potassium supplements may exert hypotensive effects of clinical ly significant degree in patients with mild hypertension & NA ; The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared : cognitive group therapy for anger control and biofeedback for heart rate control . The cognitive therapy aim ed at lowering the “ general anger ” level and helping overt expression of “ anger out ; ” heart rate biofeedback aim ed at slowing heart rate in stress situations . Ninety‐seven essential hypertensive patients were r and omly assigned to three groups ; after 20 dropouts , 77 patients fully participated in the study : cognitive treatment ( N = 30 ) , biofeedback ( N = 27 ) , and control ( no treatment , N = 20 ) . The treatments were held in 17 weekly sessions ; during treatment , blood pressure was measured once a month , and during follow‐up after 1 and 6 months . The anger level and heart rate control were assessed at the beginning and the end of treatment . The main results were : 1 ) a significant decrease of blood pressure for both treatments as compared with control , 2 ) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy , and 3 ) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback OBJECTIVE To determine whether dietary supplementation with fish oil adversely affects glycemic control in patients with hypertension . DESIGN R and omized , double-blind , placebo-controlled study . PATIENTS 78 persons with untreated hypertension recruited from a population survey . INTERVENTION Participants were r and omly assigned to receive eicosapentaenoic and docosahexaenoic acids , 4 g/d , or corn oil placebo , 4 g/d , for 16 weeks . MEASUREMENTS An oral glucose tolerance test ; assessment s of insulin release , glucose disposal , and insulin sensitivity done using the hyperglycemic clamp technique to keep plasma glucose levels at 10 mmol/L for 180 minutes ; assessment of insulin sensitivity done using a euglycemic hyperinsulinemic clamp technique ( infusing insulin and glucose to keep plasma glucose levels at 5 mmol/L ) ; assessment s of lipid levels and blood pressure . Measurements were done before and after intervention . RESULTS Changes in integrated glucose and insulin response after the oral glucose challenge did not differ between the fish oil and corn oil groups after intervention ( -0.6 + /- 0.7 compared with -1.0 + /- 0.6 mmol/L [ P > 0.3 ] for integrated glucose and 143 + /- 76 compared with 169 + /- 84 pmol/L [ P > 0.3 ] for insulin response ) . Changes in first-phase insulin release ( 34 + /- 72 pmol/L in the fish oil group compared with 191 + /- 112 pmol/L in the corn oil group [ P > 0.3 ] ) , second-phase insulin release ( 179 + /- 66 pmol/L compared with 257 + /- 122 pmol/L [ P > 0.3 ] ) , and insulin sensitivity index ( -0.03 + /- 0.01 compared with -0.01 + /- 0.01 [ mumol/kg.min divided by pmol/L ] ; P > 0.3 ) were also similar in both groups after treatment . Fish oil lowered systolic blood pressure by 3.8 mm Hg more than control ( P = 0.04 ) and lowered diastolic blood pressure by 2.0 mm Hg more than control ( P = 0.10 ) . After fish oil treatment , triglyceride levels decreased by 0.28 + /- 0.08 mmol/L more than control ( P = 0.01 ) , and very-low-density lipoprotein cholesterol levels decreased by 0.13 + /- 0.04 mmol/L more than control ( P = 0.01 ) . CONCLUSION Fish oil , in doses that reduce blood pressure and lipid levels in hypertensive persons , does not adversely affect glucose metabolism On screening 192 men and women aged 35 - 64 were identified as having two or more of the following risk factors : blood pressure greater than or equal to 140/90 mm Hg , plasma cholesterol concentration greater than or equal to 6.3 mmol/l ( 243.6 mg/100 ml ) , and current smoking habit greater than or equal to 10 cigarettes a day . They were r and omly allocated to a group for modification of behaviour or to serve as controls . Both groups were given health education leaflets containing advice to stop smoking , to reduce animal fats in the diet , and on the importance of reducing blood pressure . In addition , the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises , relaxation , and meditation and about managing stress . It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group . After four years of follow up these differences in blood pressure were maintained . Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up . At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications . Incidence of ischaemic heart disease , fatal myocardial infa rct ion , or electrocardiographic evidence of ischaemia was significantly greater in the control group . If the results of this study could be obtained in a larger study the financial and health care implication s would be enormous Objective To study the effects of a high calcium intake in hypertensive patients by blood pressure monitoring . Design In a r and omized crossover study , patients were assigned to an 8-week calcium supplementation period and an 8-week control period . The subjects were given 25 mmol/day ( 1 g/day ) of calcium as calcium carbonate during the intervention period . Setting A hypertension clinic in a tertiary teaching hospital . Patients Sixty untreated or treated hypertensive patients ( 35 men and 25 women , mean age 58 years ) with office systolic/diastolic blood pressure ≥ 140/90 mmHg . Main outcome measures Office blood pressure , home blood pressure ( last 7 days ) , and ambulatory 24 h blood pressure ( every 30 min using TM-2421 ) . Results The serum calcium concentration and urinary calcium excretion increased significantly with calcium supplementation . Office , home and 24 h blood pressure were lower in the calcium period than in the control period , although the differences were small ( mean ± SEM office blood pressure : 1.2 ± 1.2/1.1 ± 0.7 mmHg ; home blood pressure : 1.9 ± 0.7/1.3 ± 0.6 mmHg ; 24 h blood pressure : 1.2 ± 0.8/0.9 ± 0.5 mmHg , ) , and significant only for home systolic and diastolic blood pressures . The difference in home systolic blood pressure was inversely correlated with the level of home blood pressure in the control period and with the difference in urinary calcium . The difference in 24 h systolic blood pressure was positively correlated with the control level of urinary calcium . Age , sex , antihypertensive medication , drinking habit , sodium intake or order of treatment did not significantly influence the effects of calcium supplementation . Conclusions An increase in calcium intake tends to lower office , home and ambulatory blood pressure in hypertensive patients . However , the antihypertensive effect is too small to support the general application of a high calcium intake in the treatment of hypertension & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed OBJECTIVES To evaluate if magnesium alters blood pressure in hypertensive patients treated with beta blockers and if such effect can be coupled to a change in potassium and magnesium levels in muscle , serum and urine . DESIGN A r and omized double-blind , cross-over study with magnesium and placebo taken orally , each for 8 weeks . SETTING Outpatient clinic , University Hospital , Umeå , Sweden . SUBJECTS Thirty-nine patients aged 26 - 69 years with moderate essential hypertension , treated before entry and during the study with continuous , unchanged beta blockers completed the study . INTERVENTIONS R and om allocation to receive magnesium aspartate or placebo . Daily magnesium dose was 15 mmol ( 365 mg ) distributed three times a day over 8 weeks . MAIN OUTCOME MEASURES Blood pressure , serum , urine and muscle magnesium and potassium . Measurements performed at the start , after 8 and 16 weeks . RESULTS Systolic supine and st and ing blood pressure significantly decreased when magnesium was supplemented following placebo but not when magnesium was given at start . When magnesium and placebo groups were independently compared there was no significant change in supine and st and ing systolic and diastolic pressure . Serum and urine magnesium and serum potassium were significantly higher after magnesium treatment , whilst no change was present in urine potassium or in muscle magnesium and potassium . CONCLUSIONS This study showed that 15 mmol magnesium day-1 given to mild to moderate hypertensive patients treated with beta blockers could be the cause of a significant decrease in supine and st and ing systolic blood pressure Both experimental and epidemiological studies support the idea of magnesium supplementation in essential hypertension . We added 15 mmol Mg to a free diet in 71 subjects with mild essential hypertension or a high-normal blood pressure in a double-blind , placebo-controlled study over 6 months . The treatment , which raised urinary magnesium excretion 30 % , induced no general effects on the blood pressure . However , when the changes in blood pressure in the actively treated group were related to the pretreatment magnesium status , a correlation was found between pretreatment urinary magnesium excretion and the induced change in supine blood pressure ( P less than .05 ) with a blood pressure reduction in subjects with a low pretreatment urinary excretion of magnesium , and a pressor effect in the subjects with the highest pretreatment levels of urinary magnesium . The induced change in blood pressure was furthermore found to be inversely correlated to the changes in serum magnesium and urinary excretion of sodium ( P less than .03 ) induced by treatment indicating that both a direct calcium antagonist action of magnesium at the cellular level as well as a diuretic effect of the increased magnesium load might be involved in the blood pressure effects of magnesium . Pretreatment serum potassium concentration also appeared to be a predictor of the induced change in st and ing blood pressure ( P less than .03 ) . In conclusion , magnesium supplementation does not seem to be effective in unselected mild hypertensive subjects or in subjects with a high-normal blood pressure and can therefore not be generally recommended . ( ABSTRACT TRUNCATED AT 250 WORDS Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months : 24 not receiving antihypertensive-drug therapy ( Group I ) and 83 on  regular but inadequate ( despite drug manipulation ) antihypertensive-drug therapy ( Group II ) . All patients in Group I and 57 r and omly selected patients from group II ( IIa ) participated in a weight-reduction program . The remaining 26 from Group II ( IIb ) did not receive a dietary program .  Salt intake was in the normal range in all three groups . All patients on the dietary program lost at least 3 kg ( mean , 10.5 kg ) , and all but two showed a meaningful reduction in blood pressure ; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure . The weight and blood-pressure reductions were highly significant ( P less than 0.001 ) , were present in both sexes and all ages , and were directly associated . In Group IIb , no significant change in blood pressure or weight occurred ( P greater than 0.30 ) Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs , evaluated the efficacy of such programs against credible , minimally effective controls , examined the effects of these interventions on pressor responses , or clarified the nature of person by treatment interactions . The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control ( i.e. GSR biofeedback training ) in the treatment of essential hypertensives ' blood pressure at rest and in response to simulated stressful interpersonal situations . At the conclusion of an 8 week training period , stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls . The former condition maintained their lower pressures through a 6-month follow-up period , but decreases in controls over follow-up rendered the conditions equivalent in blood pressure . No differences between conditions emerged in analyses on pressor responses .  Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability OBJECTIVE To assess the long-term effects of a prepackaged , nutritionally complete , prepared meal plan compared with a usual-care diet ( UCD ) on weight loss and cardiovascular risk factors  in overweight and obese persons . DESIGN In this r and omized multicenter study , 302 persons with hypertension and dyslipidemia ( n = 183 ) or with type 2 diabetes mellitus ( n = 119 ) were r and omized to the nutrient-fortified prepared meal plan ( approximately 22 % energy from fat , 58 % from carbohydrate , and 20 % from protein ) or to a macronutrient-equivalent UCD . MAIN OUTCOME MEASURES The primary outcome measure was weight change . Secondary measures were changes in blood pressure or plasma lipid , lipoprotein , glucose , or glycosylated hemoglobin levels ; quality of life ; nutrient intake ; and dietary compliance . RESULTS After 1 year , weight change in the hypertension/dyslipidemia group was -5.8+/-6.8 kg with the prepared meal plan vs -1.7+/-6.5 kg with the UCD plan ( P<.001 ) ; for the type 2 diabetes mellitus group , the change was -3.0+/-5.4 kg with the prepared meal plan vs -1.0+/-3.8 kg with the UCD plan ( P<.001 ) ( data given as mean + /- SD ) . In both groups , both interventions improved blood pressure , total and low-density lipoprotein cholesterol levels , glycosylated hemoglobin level , and quality of life ( P<.02 ) ; in the diabetic group , the glucose level was reduced ( P<.001 ) . Compared with those in the UCD group , participants with hypertension/dyslipidemia in the prepared meal plan group showed greater improvements in total ( P<.01 ) and high-density lipoprotein ( P<.03 ) cholesterol levels , systolic blood pressure ( P<.03 ) , and glucose level ( P<.03 ) ; in participants with type 2 diabetes mellitus , there were greater improvements in glucose ( P = .046 ) and glycosylated hemoglobin ( P<.02 ) levels . The prepared meal plan group also showed greater improvements in quality of life ( P<.05 ) and compliance ( P<.001 ) than the UCD group . CONCLUSIONS Long-term dietary interventions induced significant weight loss and improved cardiovascular risk in high-risk patients . The prepared meal plan simultaneously provided the simplicity and nutrient composition necessary to maintain long-term compliance and to reduce cardiovascular  risk There is evidence that inclusion of high fiber foods such as oats , fruits and vegetables in the diet can decrease fat intake and modulate blood lipids . To test this hypothesis , 61 group A and 59 group B patients with essential hypertension were administered guava fruit preferably before meals in a foods-to-eat approach rather than foods-to-restrict , in a r and omized and single-blind fashion for 12 weeks . At entry into the study , mean age , male sex , mean body mass index , percentages of risk factors and mean levels of blood lipids were comparable between groups A and B. Adherence to guava consumption was assessed by question naires and weighing of guava intake by 24-hour recall after 12 weeks of follow-up . Nutrient intakes including saturated and total fat were significantly decreased ; carbohydrates , total and soluble fiber and vitamins and mineral intakes were significantly higher in group A than in group B at 12 weeks . There was a significant net decrease in serum total cholesterol ( 9.9 % ) , triglycerides ( 7.7 % ) and blood pressures ( 9.0/8.0 mm Hg ) with a significant net increase in high-density lipoprotein cholesterol ( 8.0 % ) after 12 weeks of guava fruit substitution in group A than in group B. By adding moderate amounts of guava fruit in the usual diet , changes in dietary fatty acids and carbohydrates may occur , providing significant amounts of soluble dietary fiber and antioxidant vitamins and minerals without any adverse effects . There is a greater decrease in lipoprotein metabolism and blood pressures Background Psychologic stress has been associated with the development of hypertension .  Aerobic exercise training appears to decrease cardiovascular responses to psychologic stress . Objective To determine the efficacy of low-intensity and moderate-intensity exercise training in reducing blood pressure and cardiovascular responses to stress . Design We sought to compare the cardiovascular responses to a psychologic stressor , the Stroop Color Word Task ( Stroop ) , before and after 12 weeks of low-intensity ( about 45 % maximal oxygen uptake ) and moderate-intensity ( about 75 % maximal oxygen uptake ) aerobic exercise training . Methods Eighteen borderline hypertensive subjects ( resting blood pressure 139 ± 9/92 ± 9 mmHg ) were divided r and omly into three groups : control ( no exercise ) , low-intensity exercise ( 40 - 50 % maximal oxygen uptake ) , and moderate-intensity exercise ( 70 - 80 % maximal oxygen uptake ) . Training groups exercised three times per week at the prescribed exercise intensity . Heart rate and blood pressure were recorded during the Stroop before , and after 4 and 8 weeks of exercise training . Results In the low-intensity exercise group , exercise training  attenuated mean blood pressure , systolic blood pressure , and diastolic blood pressure responses to the Stroop and decreased resting blood pressure . The moderate-intensity exercise group demonstrated a reduced diastolic blood pressure response to the Stroop . Conclusions These results suggest that , in borderline hypertensive humans , 12 weeks of aerobic exercise training attenuates the cardiovascular responses to the Stroop . Furthermore , low-intensity exercise training appears to a more effective stimulus than moderate-intensity exercise training in reducing resting blood pressure and blood pressure responses to stress Alcohol consumption has been recognized as an important correlate of blood pressure in many epidemiologic studies , but few interventional studies have been conducted to examine the effect of a reduction in alcohol intake on blood pressure . Because these studies have usually included few subjects and been of short duration , the National Heart , Lung , and Blood Institute ( NHLBI ) , the National Institute on Alcohol Abuse and Alcoholism ( NIAAA ) , and the Veterans Affairs ( VA ) Cooperative Studies Program have initiated a r and omized , controlled , multicenter trial to determine whether blood pressure and left ventricular mass are lowered over 6 months of alcohol moderation in non-dependent moderate to heavy drinkers ( three or more drinks per day average but not alcohol dependent ) with above-average normal ( 80 to 89 mm Hg ) and mildly hypertensive ( 90 to 99 mm Hg ) levels of diastolic blood pressure , and whether a reduction in alcohol intake can be maintained for 2 years . Eligible veterans are r and omized to either an alcohol reduction intervention or a control observation group at seven clinical sites . The projected sample size is 580 participants .  Alcohol intake is assessed by self-report using a retrospective diary ( Chronological Drinking Record ) and by various biochemical markers , including apolipoproteins , HDL cholesterol ( and subfractions ) , and carbohydrate deficient transferrin , analyzed at a central laboratory . The alcohol intervention technique is a cognitive-behavioral program , the intensive phase of which consists of six counseling sessions over 3 months . Echocardiograms are obtained at baseline and 6 months after r and omization . This trial has important implication s for both the prevention and treatment of hypertension In several trials , a blood pressure lowering effect of potassium chloride could be demonstrated . However , it is not known if other potassium salts are also effective . In a r and omized cross-over trial , 12 patients with essential hypertension were treated for 8 weeks with placebo and 120 mmol potassium per day . Potassium was given together with 50 % citrate and 50 % bicarbonate as anions .  Urinary potassium excretion rose from 61.8 + /- 8.1 to 166.7 + /- 21.2 mmol/24 hours during potassium supplementation . However , blood pressure and heart rate remained unchanged when compared to placebo . Non-chloride potassium salts may not be effective in lowering blood pressure in essential hypertension . Since potassium rich foods like fruits and vegetables contain potassium mostly as non-chloride salts , it appears to be premature to recommend a high dietary potassium intake as a mean to treat elevated blood pressure BACKGROUND Even though the effectiveness of mediation and relaxation skills is controversial in blood pressure control , extensive field studies are limited . A national study targeting 50 communities r and omly selected from northern Taiwan was conducted to test and compare the effectiveness of hypertension control incorporating three strategies . METHODS Five hundred ninety hypertensives identified from 3,128 adults at a screening survey among the 50 communities were invited to participate in the study and were r and omly assigned to three treatment modalities , ( a ) relaxation techniques training at home , ( b ) routine blood pressure measurement by a health professional , and ( c ) reading self-learning packages , or to a control group . RESULTS After a 2-month intervention period , the three treatment groups showed a significant reduction in systolic blood pressure levels compared with the control group ( 11.0 mm Hg for group 1 , 9.2 mm Hg for group 2 , and 5.1 mm Hg for group 3 ) . The relaxation group had the most significant reduction in systolic blood pressure levels , followed by the routine blood pressure monitoring group and the self-learning group . However , the effect of relaxation training at home was not significantly greater than routine blood pressure measurement by a health professional OBJECTIVES To evaluate the effects on blood pressure , lipid profile , and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program . DESIGN R and omized controlled study of a Tai Chi Chuan group and a group of sedentary life controls . SETTING Taipei Medical University Hospitals and University campus in the Taipei , Taiwan , area . SUBJECTS Two ( 2 ) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension . INTERVENTION A 12-week Tai Chi Chuan exercise training program was practice d regularly with a frequency of 3 times per week . Each session included 10-minute warm-up , 30-minute Tai Chi exercise , 10-minute cool-down . Exercise intensity was estimated to be approximately 64 % of maximal heart rate . OUTCOME MEASURES Blood pressure , lipid profile and anxiety status ( State-Trait Anxiety Inventory ; STAI ) were evaluated . RESULTS After 12-weeks of Tai Chi training , the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg . The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. By using STAI evaluation , both trait anxiety and state anxiety were decreased . CONCLUSIONS This study shows that under well- design ed conditions , Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects ' anxiety status . Therefore , Tai Chi could be used as an alternative modality in treating patients with mild hypertension , with a promising economic effect Although aerobic exercise training and diet-induced weight loss each have been shown to individually lower elevated blood pressure ( BP ) , it is currently not known whether their combined use produces an additive antihypertensive effect . In this r and omized clinical trial we therefore compared the effect on resting BP of exercise training only and dietary modification only with that of exercise training plus dietary modification in 55 sedentary , overweight patients with high normal BP or stage 1 or 2 hypertension . After baseline testing , patients were r and omized to 1 of the following 3 interventions for 12 weeks : exercise training only ( aerobic exercise ; 30 to 45 minutes ; 3 to 5 days/week ; 60 % to 85 % of maximal heart rate ) , dietary modification only ( aim ed primarily at weight loss via restriction of energy intake and dietary fat ) , or exercise training plus dietary modification .  Forty-eight patients completed the study . In these patients , exercise training plus dietary modification elicited a greater reduction ( p < or = 0.001 ) in body weight ( -7.1 + /- 2.9 vs -1.0 + /- 1.8 kg ) than exercise training only , and a greater increase ( p < or = 0.05 ) in maximal oxygen uptake ( 4.3 + /- 2.6 vs 1.9 + /- 2.0 ml/kg/min ) versus dietary modification only . However , the reduction in BP with exercise training plus dietary modification ( -12.5 + /- 6.3/7.9 + /- 4.3 mm Hg ) did not differ significantly from that with exercise training only ( -9.9 + /- 6.4/5.9 + /- 4.6 mm Hg ) or dietary modification only ( -11.3 + /- 12.1/7.5 + /- 4.3 mm Hg ) . These data indicate that the antihypertensive effects of exercise training and diet-induced weight loss are not additive . This finding has important public health and clinical implication s for the millions of overweight persons with high normal BP or stage 1 or 2 hypertension Objective To assess whether lifestyle counselling is effective in non-pharmacological treatment of hypertension in primary health care . Design Open r and omized controlled trial . Setting Ten municipal primary health care centres in eastern Finl and . Patients Seven hundred and fifteen subjects aged 25–74 years with systolic blood pressure 140–179 mmHg and /or diastolic blood pressure 90–109 mmHg or antihypertensive drug treatment . Interventions Systematic health counselling given by local public health nurses for 2 years . Main outcome measures Blood pressure , lipids and lifestyle data were collected annually . Results Among participants with no antihypertensive drug treatment , the net reductions after 1 year both in systolic blood pressure [ −2.6 mmHg ; 95 % confidence interval ( CI ) , −4.7 to −0.5 mmHg ] and in diastolic blood pressure ( −2.7 mmHg ; 95 % CI , −4.0 to −1.4 mmHg ) were significant in favour of the intervention group . This difference in blood pressure change was maintained during the second year . In participants with antihypertensive drug treatment , no significant difference in blood pressure reduction was seen between the groups during the study . Conclusions A relatively modest , but systematic counselling in primary health care can , at least among untreated hypertensive subjects , produce reductions in blood pressure levels that are modest for the individual , but very important from the public health point of view One hundred and one patients , 70 experimental and 31 controls , with a diagnosis of essential hypertension , were examined for the effects of group relaxation training and thermal biofeedback on blood pressure and on other psychophysiologic measures : heart rate , forehead muscle tension , finger temperature , depression , anxiety , plasma aldosterone , plasma renin activity , and plasma and urinary cortisol .  Eighty percent of the participants were medicated . Treatment yielded a short-term success rate , defined as a decrease in mean arterial pressure of 5 mm Hg , of 49 % in the experimental group . Other significant short-term changes included a reduction of forehead muscle tension , state anxiety , plasma aldosterone , and increased finger temperature . Follow-up measurements were made approximately 10 months after treatment in 36 patients , 51 % of the treatment completers . Twenty of the 36 were short-term treatment failures , while 16 were treatment succeeders . Thirty-seven percent of the short-term succeeders continued to meet blood pressure criterion at follow-up . In short-term succeeders , continued practice of relaxation may influence long-term maintenance of decreased blood pressure . It is suggested that group relaxation training can be beneficial for short-term and long-term adjunctive treatment of essential hypertension  in selected individuals Mild essential hypertensive patients comprise a large portion of the hypertensive population . Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure . By design ing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters . Twenty-three mild hypertensive Taiwanese patients ( resting blood pressure 139.1±11.4/99.5±8.0 mmHg ) were divided r and omly into two groups : control ( no exercise ) and moderate-intensity exercise ( average 6.4±0.7 METs ) . The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test . Blood pressure , heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks . After 12 weeks regular exercise training , the exercise group showed for significant resting blood pressure reduction . Mean maximal reduction of systolic pressure was 18 mmHg . Significant reduction of total cholesterol , low-density lipoprotein cholesterol ( LDL-C ) and triglyceride were found ; elevation of high-density lipoprotein cholesterol ( HDL-C ) was also noted . These data suggest that after 12 weeks of exercise training in mild hypertensive patients , successful reduction of blood pressure and favorable changes of lipid profile will be noted The aim of the study was to test the effect of a non-pharmacological weight reduction program on cardiovascular risk factors among overweight hypertensives in a primary health care setting . Forty-nine overweight hypertensive patients completed the 12-month program . The patients were r and omly allocated into either intervention or control groups . The examinations included interviews by a nutritionist , pertinent laboratory tests , and a medical examination . The intervention involved an individually planned energy-restricted diet of 1000 - 1500 kcal per day , weekly discussion s , and various leaflets on diet modification and on increase of physical activity . The mean body weight was reduced by 5 kg in the intervention group , but remained unchanged in the control group . The intervention group reduced their fat intake by 14 g/day while the control group increased it by 9 g/day on the average . In the intervention group , the total serum cholesterol decreased , HDL-cholesterol increased and triglycerides decreased significantly . The systolic blood pressure fell by 8 mm Hg and 15 mm Hg in the intervention and control groups , respectively . The diastolic blood pressure fell on average by 11 mm Hg in both groups . The results demonstrate the comprehensive weight reduction program to be effective in the control of cardiovascular risk factors To study the effects of long-term , home-based exercise on physical fitness and cardiovascular risk factors of middle-aged nonsmoking males , a controlled study was conducted in 61 sedentary Swiss men . Thirty-nine men were r and omly allocated to jog 2 h/week for 4 months on an individually prescribed and heart-rate-controlled basis , whereas 22 men served as controls . Despite varying adherence to the exercise regimen , the 4-month net change ( effect in exercise group minus effect in control group ) in estimated endurance capacity was significant and positive . Net changes in arterial blood pressure , measured with a r and om-zero device , were nonsignificant , but after exclusion of low-normotensive men ( n = 19 ) from analysis , a significant net effect of exercise on diastolic blood pressure was seen ( -4.3 mmHg ; p = .048 ) . The following net changes in serum lipid levels occurred : HDL cholesterol + 0.12 mmol/l ( p = .028 ) , total triglycerides -0.21 mmol/l ( ns ) , HDL-C/total cholesterol ratio + 0.02 ( p = .047 ) . Exploratory analyses revealed that an increase in estimated endurance capacity was associated with a rise in systolic and diastolic blood pressure ( r = 0.49 and 0.43 , respectively ; p less than 0.01 both ) . Changes in the waist-hip ratio were directly related to the change in diastolic blood pressure ( r = 0.27 ; p less than 0.05 ) . Multivariable analysis indicated that much of the beneficial effect of exercise on diastolic blood pressure was apparently mediated through a decrease in body fat . This study confirms that individually prescribed jogging can reduce cardiovascular risk factors in self-selected nonsmoking males . ( ABSTRACT TRUNCATED AT 250 WORDS Two-hundred- and -twelve untreated subjects ( mean age 52.3 + /- 0.8 years ; 181 males and 31 females ) with a diastolic blood pressure between 90 and 100 mmHg were recruited to the study . Subjects were seen fortnightly and , after 4 pre-diet visits , were r and omized into a normal diet group ( A , 55 subjects ) , a high-potassium diet group ( B , 52 subjects receiving greater than 100 mmol K+/day ) a reduced-sodium diet group ( C , 52 subjects receiving 50 - 75 mmol Na+/day ) or a high-potassium and low-sodium diet group ( D , 53 subjects receiving same Na+ and K+ as groups B and C ) . Two-hundred subjects completed the diet phase of 12 weeks . Urine sodium fell to 86 + /- 7 mmol/day in group C and 73 + /- 6 mmol/day in group D , while daily potassium excretion rose to 96 + /- 5 mmol in group B and 87 + /- 4 mmol in group C. Systolic and diastolic blood pressure fell by 3.8 + /- 1.0 and 1.6 + /- 0.6 mmHg respectively in the normal diet group . The falls in systolic and diastolic blood pressures ( mmHg ) in the diet phase were 7.7 + /- 1.1 and 4.7 + /- 0.7 ( B ) , 8.9 + /- 1.0 and 5.8 + /- 0.6 ( C ) and 7.9 + /- 0.9 and 4.2 + /- 0.7 ( D ) . These falls were all greater than those in the control group on an intention-to-treat analysis ( P less than 0.005 ) but did not differ from each other . Factorial analysis confirmed that the falls in pressure attributable to the low-sodium diet and high-potassium diet were not additive . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE --To establish whether stress management had a larger effect than a control treatment on resting blood pressure , ambulatory blood pressure , and left ventricular mass . DESIGN --A 12 week baseline period of habituation to measurement of blood pressure was followed by r and omisation to either stress management or mild exercise for six months and follow up six months later . SETTING --General practice , district general hospital , and medical school . PATIENTS --Of the 184 patients aged under 60 with mild primary hypertension who entered the baseline habituation period , 88 were excluded because they failed to meet the entry criteria or they withdrew from the study . The remaining 46 men and 50 women underwent treatment . INTERVENTIONS --10 clinical sessions and daily practice at home of either stress management based on relaxation or non-aerobic stretching exercises . Mildly stressful 15 minute interviews before and after treatment . MAIN OUTCOME MEASURES --Diastolic and systolic blood pressure in the clinic and during 12 hours of ambulatory recording , and left ventricular mass measured by echocardiography . RESULTS --The patients ' blood pressure fell during habituation ( systolic pressure from 152 mmHg to 140 mmHg , diastolic pressure from 98 to 93 mm Hg ) , but neither resting nor ambulatory blood pressure was changed by the treatments . Left ventricular mass was also unchanged . Blood pressure rose during the stressful interview , but this rise was reduced by stress management ( systolic pressure rose by 7.4 mmHg before treatment and by 3.7 mmHg after treatment ) . CONCLUSION --Stress management of a type advocated for treating mild primary hypertension is ineffective in lowering blood pressure in patients who are well habituated to measuring blood pressure We examined the interactions between sodium and calcium responsiveness of blood pressure by study ing the effects of calcium supplementation in 46 normotensive and hypertensive subjects who had been previously characterized as salt sensitive or salt resistant on the basis of their blood pressure responses to rapid sodium and extracellular volume expansion and contraction . The calcium supplementation study utilized a placebo-controlled , double-blind , r and omized crossover design . Subjects received calcium carbonate supplementation ( 1.5 g/day ) for 8 weeks or matching placebo , with 2-week placebo lead-in and crossover periods . For the entire group , no significant blood pressure changes were seen with calcium supplementation . When the subjects were separated on the basis of race or prior salt sensitivity , significant differences were seen . Blacks and salt sensitive subjects exhibited a significant ( P < .05 ) blood pressure decrease when compared to their counterparts . Calcium sensitive subjects had significantly ( P < .02 ) lower levels of plasma renin activity than those not demonstrating a decrease in blood pressure with added calcium . When urinary calcium excretion of subjects previously defined as salt sensitive or salt resistant were compared , the former had significantly ( P < .001 ) higher calcium excretion values at baseline as well as during the placebo and calcium supplementation periods than did the latter . There were no known differences in dietary calcium intake to account for the striking urinary findings . These observations confirm the heterogeneity of blood pressure response to calcium supplementation and demonstrate congruity between sodium and calcium responsiveness of blood pressure in normal and hypertensive humans . ( ABSTRACT TRUNCATED AT 250 WORDS In a double-blind trial 90 mildly hypertensive subjects aged 16 - 29 years were r and omly assigned to 1 g calcium per day or placebo . Calcium supplementation did not affect systolic blood pressure , but at six and twelve weeks diastolic blood pressure had fallen by 3.1 ( p = 0.04 ) and 2.4 ( p = 0.11 ) mm Hg , respectively , more in the calcium group than it had in the placebo group . Subjects with a baseline plasma parathyroid hormone ( PTH ) higher than the median showed a 6.1 mm Hg ( p = 0.01 ) greater fall in diastolic blood pressure after six weeks and 5.4 mm Hg ( p = 0.01 ) after twelve than in the placebo group . The fall in diastolic blood pressure was greater in the calcium group than in the placebo group in subjects with a lower than median serum total calcium and in those with a large bodyweight . Calcium supplementation may lower blood pressure in young people with mildly raised blood pressure , particularly in those with high plasma PTH and /or low serum total calcium 51 patients with mild essential hypertension ( EH ) were r and omly divided into two groups ; the first group ( 31 patients ) was treated with 1 g. of oral calcium during a period of 8 weeks ; the second group received a placebo . The treated with calcium showed a significant decrease in blood pressure ( BP ) , the maximal reduction being of 6 mm Hg in the systolic pressure ( SBP ) and 3 mm in the diastolic ( DBP ) at the end of the 8th week . We found a substantial positive relationship between the decrease in SBP and seric renin activity ( p less than 0.05 ) , as well as a significant negative relationship ( p less than 0.05 ) between DBP and the seric level of parathyroid hormone ( PTH ) . During the administration of the oral calcium supplement , the BP decreased in an inverse proportion to the plasmatic renin and seric level of PTH I Canadin Task Force .  Cervical cancer screening programs  , 1976 . Can Med Assoc j 1976 ; -114:1003 - 33 . 2 Canadian Task Force . Cervical cancer screening p s : summary of the 1982 CanadianTask Force report . CanMedAssocj 1982;127:581 - 9 . 3 Dep tofHealth and Soail Security . Heach sevies&vdop eascgfor cervical caucr . Lod : DHSS , 1984 . ( HC(84)17 . ) 4 NlHConenssStst . Cervicalc ecreening : the Pap smear . BrMedJ 1980;281:1264 - 6 . 5 Macgregor JE , Baird D. Detection of cvial carcinoma in the genral population . Br MadJ 1963;i : 1631 - 6 . 6 Macgreg JE . Evaludon ofms scening programmes for cervial cancer in NE Scod and . Tonsori 1976;62:287 - 95 . 7 Macgregor JE , Moss SM , Parkin DM , Day NE . A case-control study ofeva cancercrening in orth ast Scodind BrMedY 1985;2:1543 - 6 . 8 Fidler HK , Boyes DA , Worth AJ .  Cervical cancer detection in British Columbia . A progress report . Jo fObs iasaGynaeology ofte tis ComBsdet 1968;75 : 392 - 404 . 9 Boye DA , Morrion B , Knom EG , Daper GJ , MiLlatAB . A coott sudy of cevical ca screeningmBritish Columbia . Cli lxveuiMod 1982;5:1 - 29 . 10 Thorainson A , Jenison 0 , B-prnason 0 . Screeniig for uterine cancer in  Icel  and . Aca Cytol 1969-,13 302 - 8 . 11 Johanneso G , Geiriaon G , Day NE . Th effect of m screening in Iceld 1m65 - 74 on the incidece and mortality ofcvical carcnoma . IxtJ Caxcer 1978;21:418 - 25 . 12 Johannesson G , Geirsson G , Day NE , Tulinius H. Sceening for cancer of the uterine cerv in Icd and -1965 - 1978 . Acta Obstet GynecolSc and 1982;61:199 - 203 . 13 Choi NW , Nelson NA , Abu-Zeid HAH . Cervical cytology program and its effects on cevcal cancer  incidnce and mortality by geographical areas in Manitoba . In : Nieburgs HE , ed . Prvention and detection ofcancer . Vol 2 , pt II . New York : Marcel Dekker , 1980:1891 - 907 . 14 Berget A. Influence of populaion sreening on morbidity and mortality of cancr of the uterine cervixin Maribo Amt . DanMd BMBl 1979;26:91 - 100 . 15 Lyage E , Poll P. Incdence of cevical following neptie smear . A cohort study from Manibocounty , Denmark . AmEpideasidin p .s ) . 16 Berget A , Mailer KA , Ol1sen JL Poll P. esrnigfor cervical crioain Maribo Amt 1971 - 1975 . DaxnMedBull 1978;2S:232 - 4 . 17 Norwegian Cancer Society . Mass saenmg fr canwff of sinetaramn cervixmi Oszfold cmmxgy 19591965 . Report No 1 . Oslo : Norwegian Cancer Society , 1967 . 18 Pedersen E , Hoeg K , Kolstad P.  Mmassceeningforcanceroftheuterinecervix  in Ostfold county , Norway : an experiment . Second report of the Norwegian Cancer Society . Acta Obstea Gynecol Sc and [ Suppl ] 11 , 1971 . 19 Ho'ugen A. Mms screening for  cafice of the uternDe cervix in the county of Ostfold , Norway . In : Nieburgs HE , ed . Prevention and desecion ofcancer . New York : Marcel Dekker , 1980:1875 - 84 . 20 Stenkvist B , BergstromR , Ekhund G , FoxCH . Papanicolaou smnearscreening and cervical cancer . What can you expect?_JAmMedAssw 1984;252:1423 - 6 . 21 Pettersaon F , Bj6ekbhol E , Nislund I. Evaluatio of the effect of Papnmcolaou screening in Sweden.2 . Trends in incidence and mmortalt for cancer of the uterine cervix  in Sweden 1958 - 1980 . IntyjEpikdeaia(inpress ) : 22 Raymond L , Obradovic M , Riotton G. Une 6tude csa-tenxina pour 1'6valuation du depistag cytologique du cancer du col uterin . RevEpidemiolSantePubique 1984;32:10 - 5 . 23 Berrino F , GattaG , D'alto M , Crosignani P , Riboli E. Efficacy fsreeningimpreventinginvasive cervical cancer . A case-control study carried outin Milan , Italy . In : HakamoaM , MiIIerAB , Day NE , eds . Screexingfor cervical cancer . Lyon : International Agency for Research on Cancer ( in press ) . ( IARC Scientific Publications , No 76 . ) 24 Clarke EA , And erson TW . Does screeningby " Pop " smearshelp prevent cervsia cancer ? Acasecontrol study . Lances 1979;ii:14 . 25 Hakama M , Day NE , MilkerAB , eds . Sreenmgfor cervi ~ cawaner.-Lyon : International Agencyfor Research on Cancer(inprea ) . ( LARC Scientific Publicanons , No. 76 . ) 26 Day NE , Walter SD . Siniplsfied modelsforscreening : estimation procedures fiommass screening programmres . Biometrics 1984;40:1 - 14 . 27 Brookmeyer R , Day NE , Mosa S. Case-contrxotatuidies for the estimation of the natural history of precdinicaf disease from screening data . StauMed IM8S:127 - 38 .28 Store BE , Wachoklder 5 , BreslowNE . Maximum likelihood flttingofgeneralrelative risk models to stratified data . AppliedStastst 1983;32:172 - 81 . 29 LaVecchia C , Franceschi5 , Decali A , FasoliM , GentileA , TognoniG. " Pap " smear and the risk of cervical neoplasia : quantitative estimates from a case-control study . Lances 1984ssi779 - 82 . 30 Aristizabal N , Cuello C , Correa P , Collaxos T , Haenszel W. The  impact of vaginal cytology on cervical cancer rinks in Cali , Colombia . I1u4 Cancer 1984;34:5 - 9 . 31 Hakama M. Trends in theincidenceofcervica cancerin the Nordic cotunties . In : Magnus K , ed . Trends in cancer inciene . Washington : Hemisphere , 1982:279 - 92 Fifty-two pharmacologically treated hypertensive patients were r and omized to one of four treatment groups : ( 1 ) diastolic blood pressure biofeedback , ( 2 ) progressive deep muscle relaxation training , ( 3 ) self-directed relaxation training , or ( 4 ) medication alone . Data collection occurred during baseline , treatment , and 1-year follow-up phases in a laboratory , a medical clinic , and the patient 's own home . Patients from all four groups combined showed mean blood pressure reductions of −10.2/−5.5 mm Hg on clinic recordings and −2.4/−.7 mm Hg on home recordings , which were maintained throughout the follow-up period . There were no significant differences among the four groups in terms of blood pressure reduction . Patients given adjunctive behavioral treatment showed significantly larger reductions in medication usage compared to patients treated with medication alone , but there were no significant differences among the three behaviorally treated groups . Patients who showed medication reductions did not show subsequent blood pressure elevation . The results suggest that combined behavioral and pharmacological therapy may be superior to pharmacological therapy alone in the treatment of essential hypertension The present study set out to assess the feasibility of long-term moderate dietary sodium restriction in patients with mild hypertension in general practice . After screening and a run-in phase of 6 - 8 weeks , a total of 77 previously undiagnosed mildly hypertensive patients were identified . Half of them were r and omized to receive a few simple dietary instructions from their general practitioners in order to reduce salt usage ; the others were r and omized to receive no advice . The patients were followed up for 12 months with quarterly visits . A total of 56 patients ( 72.7 % ) completed the study , 26 on a low-sodium diet ( LD ) and 30 on their usual diet ( UD ) . At each visit in the diet phase , patients provided 24h urine , which was analysed for volume and sodium concentration in order to assess their sodium intake . Blood pressure , heart the rate and body weight were recorded . The mean urinary sodium excretion for all diet phase visits overlapped in the two groups ( 177.0 + /- 32.9 vs. 169.3 + /- 49.4 mEq/24h respectively in the LD and UD groups ) . Nevertheless the mean systolic and diastolic blood pressures for all diet phase visits were significantly lower in the LD than in UD group ( 144.2 + /- 11.1/91.6 + /- 6.4 and 148.0 + /- 13.7/95.6 + /- 4.7 mmHg respectively , P less than 0.01 ) . Our data suggest that it is not feasible at present to reduce sodium intake in mild hypertensives with simple and inexpensive dietary instructions , the only ones suitable for widespread application in general practice & NA ; In this industrial‐based study we compared the blood pressure (BP)‐lowering effectiveness of relaxation , a beta blocker , and the combined use of these two treatments in 47 untreated , mildly hypertensive blue collar steel workers . Using a r and omized two by two factorial design , patients received either nadolol or placebo drug daily , and either a relaxation training or an education program , each lasting 8 weeks . A pre‐intervention and post‐intervention stress test measured response of heart rate and BP to mental and physical tasks . BP assessment s were done at baseline , post‐intervention , 1 month , and 3 month follow‐up . Change in several self‐report measures was determined . Results showed that beta blocker was more effective in lowering BP than placebo , but relaxation was not more effective in lowering BP than health education . The combined effect of beta blocker and relaxation was not superior to beta blocker alone . Compliance with relaxation practice was not superior to compliance with medication . We conclude that pharmacologic treatment is superior to the relaxation therapy tested In a double-blind , r and omized , placebo-controlled , crossover trial , 23 middle-aged patients with mild to moderate essential hypertension were given an oral calcium supplement ( 1 g/day ) for 8 weeks . At the end of this period , eight patients continued with this treatment for an additional 2 weeks but were also given 0.5 micrograms/day of 1,25-(OH)2 vitamin D3 . In the 21 patients who completed the study , arterial pressure during the calcium-supplemented phase was almost identical to that of the placebo phase . In eight patients , mean arterial pressure ( MAP ) had changed by greater than 5 mmHg at the end of the calcium-supplemented period , compared with the end of the placebo phase ( six patients showed an increase in MAP and two a decrease ) . Changes in arterial pressure were unrelated to age , plasma ionized calcium , parathyroid hormone ( PTH ) , plasma renin activity ( PRA ) , plasma aldosterone , 24-h urinary calcium , sodium and potassium and were only weakly related to body weight . In the eight patients who continued with the treatment of calcium plus 1,25-(OH)2 vitamin D3 after the 8-week study period , arterial pressure changed very little and not significantly . These results do not support the suggestion that calcium supplements lower arterial pressure in middle-aged subjects with mild to moderate essential hypertension Thirty-two male and female hypertensives , 34 to 65 yr of age , systolic blood pressure ( SBP ) less than 200 mmHg and diastolic blood pressure ( DBP ) between 90 and 109 mmHg , were r and omly allocated to receive either relaxation and stress management ( experimental condition ) or mild physical exercise ( control condition ) . Half the participants were taking antihypertensive drugs , which were constant for six months prior to the study and controlled during the study . Outcome measures included various measures of blood pressure in the clinic and at home , cardiovascular responsiveness , moods and 24-hr urinary adrenaline and noradrenaline . The study schedule consisted of 3-months baseline , 10 weeks treatment and 3-months follow-up . Relaxation was superior to the control procedure in reducing blood pressure as assessed by nurses blind to the participants ' treatment at post-treatment for DBP and at follow-up for DBP and SBP Abstract Objective : To examine the effect of a reduced sodium and increased potassium and magnesium intake on blood pressure . Design : R and omised double blind placebo controlled trial . Setting : General population of a suburb of Rotterdam . Subjects : 100 men and women between 55 and 75 years of age with untreated mild to moderate hypertension . Interventions : During 24 weeks the intervention group received a mineral salt ( sodium : potassium : magnesium 8:6:1 ) and foods prepared with the mineral salt . Controls received common salt and foods . Main outcome measure : Change in blood pressure . Results - Complete follow up was achieved for 97 of the 100 r and omised subjects .  Systolic blood pressure ( mean of measurements at weeks 8 , 16 , and 24 ) fell by 7.6 mm Hg ( 95 % confidence interval 4.0 to 11.2 ) and diastolic blood pressure by 3.3 mm Hg ( 0.8 to 5.8 ) in the mineral salt group compared with the controls , with a 28 % decrease in urinary sodium excretion and a 22 % increase in urinary potassium excretion . Twenty five weeks after the study the difference in blood pressure between the groups was no longer detectable . Conclusion : Replacing common sodium salt by a low sodium , high potassium , high magnesium mineral salt could offer a valuable non -pharmacological approach to lowering blood pressure in older people with mild to moderate hypertension Thirty-five patients with mild to moderate hypertension were r and omised into a three months ' dietary advised and a three months ' control group . The diet was of a composition currently considered to be appropriate , and was monitored by a dietitian . Statistically significant decreases in diastolic blood pressure , mean arterial pressure , sodium excretion , and low density lipoprotein (LDL)-cholesterol occurred in the intervention group , although differences in change between the intervention and the control group were , except for LDL-cholesterol , not statistically significant . Thus , it did not become clear whether and to what extent change in diet was responsible for the lowering of the blood pressure in the intervention group On the basis of medical officers diagnosis , thirty three ( N = 33 ) hypertensives , aged 35 - 65 years , from Govt . General Hospital , Pondicherry , were examined with four variables viz , systolic and diastolic blood pressure , pulse rate and body weight . The subjects were r and omly assigned into three groups . The exp . group-I underwent selected yoga practice s , exp . group-II received medical treatment by the physician of the said hospital and the control group did not participate in any of the treatment stimuli . Yoga imparted in the morning and in the evening with 1 hr/session . day-1 for a total period of 11-weeks . Medical treatment comprised drug intake every day for the whole experimental period . The result of pre-post test with ANCOVA revealed that both the treatment stimuli ( i.e. , yoga and drug ) were effective in controlling the variables of hypertension OBJECTIVE : To examine the effects of a GP exercise referral programme on modifiable  coronary heart disease risk factors . DESIGN : R and omised controlled trial . A battery of vali date d measures were carried out at 0 , 8 , 16 , 26 , and 37 weeks . SETTING : Two community health centres and a leisure centre in Hailsham , East Sussex . SUBJECTS : 389 patients ( smokers , hypertensive or overweight ) were selected from medical records , screened for contraindications to exercise and 345 were invited into the study . Of 142 patients r and omly allocated , 40 ( 41 % ) completed the study in the exercise group and 31 ( 69 % ) in the control group .  Sixty ( 35 % ) invited smokers ( 48 % of non-smokers ) , 71 ( 38 % ) invited hypertensive patients ( 45 % of non-hypertensive patients ) , and 107 ( 45 % ) overweight patients ( 33 % of non-overweight patients ) were r and omised . Of those r and omised , 27 ( 45 % ) smokers , 52 ( 48 % ) overweight , and 43 ( 61 % ) hypertensive patients completed the study . INTERVENTION : The exercise group was offered 20 , half price sessions over 10 weeks at a leisure centre . Patients engaged in moderate and vigorous aerobic type activity on various exercise machines , in a semi-supervised , informal environment . RESULTS : 87 % of those referred used the prescription and 28 % ( high adherers)(45 % of obese patients ) did at least 15 sessions . The exercise group reduced sum of skinfolds by 8.1 % ( 2.9 to 13.3 , 95 % confidence intervals ) more than the control group , up to 16 weeks after baseline . High adherers reduced sum of skinfolds by 9.2 % ( 0.9 to 17.5 ) more than the control group , up to 26 weeks . High adherers reduced systolic blood pressure by 7.2 % ( -0.7 to 14.9 ) ( that is , 9 mm Hg ) more than low adherers , up to 37 weeks . Non-smokers and obese patients attended more prescribed sessions than smokers and non-overweight patients . CONCLUSIONS : Reduction in sum of skinfolds was maintained up to 26 weeks , among high adherers compared with controls . Reduction in systolic blood pressure was evident up to 37 weeks among high adherers , but only in comparison with low adherers . Selection of appropriate referees and use of other strategies to improve exercise adherence will help to maximise the benefits from GP exercise prescription schemes We conducted a double-blind , placebo-controlled crossover study to determine the effects of fish oil supplementation on blood pressure in middle-aged men . Subjects were r and omly assigned to consume either 20 g of fish oil or safflower oil for 12 weeks and then consume the other oil for an additional 12 weeks after a 4-week washout period . We found no significant changes from the pretreatment value in systolic or diastolic blood pressure with the use of fish oil supplements . In addition , there were no significant differences in the posttreatment blood pressures comparing the fish and safflower oil phases of the study A controlled prospect i ve study compared two groups of obese hypertensive subjects during 12 weeks of a hypocaloric protein-supplemented fast containing 40 mEq of sodium daily . One group received additional sodium chloride sufficient to maintain baseline sodium intake measured prior to the fast ( 210 m/Eq/day ) . Sodium restriction result ed in greater weight loss and slightly greater BP reduction only during the initial week of fasting . Thereafter , despite sodium equilibrium , further substantial weight loss and BP reduction were identical in both groups , the decrement in weight being linear ( 1.89 kg/wk ) and the BP reduction asymptotic . Although the initial reduction in BP during the first week of supplemented fast may be attributable to negative salt and water balance , the further reduction in BP during a period of constant sodium balance must be caused by weight loss per se or by the triggering of other antihypertensive mechanisms associated with weight reduction Thirty-one patients receiving medical treatment for essential hypertension were r and omly distributed into three groups : ( 1 ) relaxation therapy , ( 2 ) nonspecific therapy , and ( 3 ) medical treatment only . The nonspecific therapy group spent the same amount of time with the therapists as the relaxation group but was not given a specific therapy .  Blood pressures were measured at a different time and in a different place from the behavioral treatments . The relaxation therapy group showed a significant reduction in blood pressure postreatment compared with the nonspecific therapy and medical treatment only groups , even when those patients whose medication was increased were excluded from the data analysis . At follow-up six months post-treatment , the relaxation group showed a slight decrement in treatment effects , while both the nonspecific therapy and medical treatment only groups showed continued improvement ; thus , there was not a significant difference between groups & NA ; The present study describes a 16‐week trial of the use of a combination of biofeedback and relaxation techniques for the treatment of hypertension . Twenty‐two hypertensive patients were r and omly allocated to one of three groups : ( 1 ) diastolic blood pressure feedback , electromyographic feedback , and verbal relaxation ; ( 2 ) sham blood pressure feedback ; and ( 3 ) no treatment . For the 14 patients completing active treatment during an initial or crossover period , the average changes in blood pressure as measured outside the laboratory were minimal ( 0/−1 and + 1/0 mm Hg , supine and st and ing , respectively ) . Average blood pressure reduction in the laboratory was no greater with active than with sham blood pressure feedback ( −3/−2 vs. −5/−2 mm Hg ) . One subject , however , after showing no change in blood pressure during sham feedback , achieved pronounced and prolonged improvement following active treatment . Overall results do not support the usefulness of these techniques as primary therapy in most hypertensives STUDY OBJECTIVE To evaluate the effects of omega-3 fatty acids on blood pressure control and lipid levels . DESIGN Double-blind , placebo-controlled , r and omized study . SETTING Veterans Affairs Medical Center teaching hospital . PATIENTS Twenty-one men whose blood pressure was not optimally controlled with antihypertensive agents , who met the inclusion criteria . INTERVENTIONS Patients were r and omized to receive either fish oil ( 4.5 g omega-3 fatty acids/day ) or placebo . MEASUREMENTS AND MAIN RESULTS Blood pressure readings were taken at baseline , and 4 and 8 weeks . Sitting systolic and diastolic blood pressures were significantly reduced in the fish oil group at both week 4 ( 148/97 to 132/90 , p < 0.05 ) and week 8 ( 148/97 to 134/91 , p < 0.05 ) . Sitting diastolic blood pressure was significantly reduced in the placebo group at week 8 ( 94 to 88 , p < 0.05 ) . There was no difference in percentage change of sitting systolic and diastolic pressures at week 8 comparing the placebo group ( -6.4 % and -6.3 % , respectively ) and the fish oil group ( -8.8 % and -6.6 % , respectively ) . Triglyceride levels ( -40.9 % , p < 0.05 ) and platelet counts ( -8.7 % , p < 0.05 ) were significantly reduced at 4 weeks , and low-density lipoprotein ( LDL ) cholesterol levels were significantly increased both at 4 and 8 weeks ( 13.5 % and 19.1 % , respectively ) in the fish oil group . CONCLUSION Adjunctive fish oil supplementation did not substantially augment blood pressure lowering in treated hypertensive men with suboptimally controlled blood pressure . Effects on plasma lipid values were mixed , with an increase in LDL cholesterol and a decrease in plasma triglyceride levels Eighty patients with essential hypertension , stages IIA-IIB , were examined three times : on admission to hospital , and 1 and 12 months later . All patients were subjected to clinical , psychological ( brief multifactorial question naire for examination of a personality and the interpersonal relationships test ) and psychophysiological investigation . The patients were allocated to 3 groups by r and om selection :  30 patients practicing autogenic training ( group 1 ) , 30 patients on relaxation therapy making use of biological feedback ( BFB ) ( group 2 ) , and 20 patients exposed to no psychological influences ( group 3 , or the controls ) . In the presence of psychological treatment , the BP decline , the increase in stress tolerance and the improvement of the psychological status were significantly more marked in the former two groups , as compared to the controls . Comparative assessment of the efficiency of autogenic training and BFB showed no basic differences between the two treatment methods . In cases where treatment proved inefficient , the patients exhibited a negative attitude to treatment and markedly demonstrative character The blood pressure response of 48 hypertensive persons and 32 normotensive persons to elemental calcium ( as the carbonate or citrate salt ) , 1000 mg/d for 8 weeks , was assessed in a r and omized , double-blind , placebo-controlled , crossover trial . Compared with placebo , Ca2 + significantly lowered supine systolic blood pressure by 3.8 mm Hg , st and ing systolic blood pressure by 5.6 mm Hg ( p less than 0.02 ) , and supine diastolic blood pressure by 2.3 mm Hg ( p less than 0.05 ) in hypertensive persons . The response in normotensive persons differed significantly from that in hypertensives ( p less than 0.03 ) as their blood pressure was unchanged . Twenty-one ( 44 % ) hypertensive and 6 ( 19 % ) normotensive persons achieved a reduction in st and ing systolic arterial pressure of 10 mm Hg or greater . Reported adverse effects were similar between calcium and placebo phases and did not necessitate withdrawal of any patient from the trial . Treatment with 1000 mg/d of oral Ca2 + for 8 weeks represents a safe , well-tolerated , nonpharmacologic intervention that lowers blood pressure in selected patients with mild to moderate hypertension BACKGROUND Diet is an essential part of the nonpharmacological management of hypertension . The aim of this study was to investigate in a primary health care setting the effect of intensified diet counseling on the diet of hypertensive subjects . METHODS A total of 715 free-living subjects , ages 25 - 74 years , with systolic blood pressure 140 - 179 mm Hg and /or diastolic blood pressure 90 - 109 mm Hg and /or drug treatment for hypertension participated in an open r and omized trial with a 2-year follow-up at health centers in eastern Finl and . The intervention group ( n = 360 ) was advised to reduce their total fat , saturated fat , and salt intake and to increase monounsaturated and polyunsaturated fat intake as well as to reduce weight and to use alcohol in moderation if at all . The usual care group ( n = 355 ) continued with their usual primary health care . The subjects filled out a 4-day food record , and 24-h urine sample s were collected at baseline and at 1- and 2-year examinations . RESULTS The 2-year net changes ( change in intervention minus change occurring in usual care group ) in total fat intake [ -2.7 E% ( 95 % CI -4.0 , -1.6 ; P < 0.0005 ) ] , in saturated fatty acid intake [ -1.7 E% ( 95 % CI -2.3 , -1.1 ; P < 0.0005 ) ] , and in body weight [ -1.4 kg ( 95 % CI -2.0 , -0.8 ; P < 0.0005 ) ] were significant . Furthermore , the 2-year net change in daily sodium intake was significant , -9 mmol ( 95 % CI -17 , -2 ; P = 0.021 ) , but the 24-h urinary sodium excretion showed no difference between the study groups . CONCLUSION The intensified diet counseling in primary health care result ed in dietary changes interpreted as being of benefit in the long-term treatment of hypertension and prevention of atherosclerotic vascular diseases OBJECTIVES : Evaluate whether weight-loss diets are more effective than regular diets or other antihypertensive therapies in controlling blood pressure and preventing morbidity and mortality  in hypertensive adults . SEARCH STRATEGY : MEDLINE and The Cochrane Library were search ed through November 1997 . Trials known to experts in the field were included through June 1998 . SELECTION CRITERIA : For inclusion in the review , trials were required to meet each of the following criteria : 1 ) r and omized controlled trials with one group assigned to a weight-loss diet and the other group assigned to either normal diet or antihypertensive therapy ; 2 ) ambulatory adults with a mean blood pressure of at least 140 mm Hg systolic and /or 90 mm Hg diastolic ; 3 ) active intervention consisting of a  calorie-restricted diet intended to produce weight loss ( excluded studies simultaneously implementing multiple lifestyle interventions where the effects of weight loss could not be disaggregated ) ; and 4 ) outcome measures included weight loss and blood pressure . DATA COLLECTION AND ANALYSIS : Studies were dual abstract ed by two independent review ers using a st and ardized form design ed specifically for this review . The primary mode of analysis was qualitative ; graphs of effect sizes for individual studies were also used . MAIN RESULTS : Eighteen trials were found . Only one small study of inadequate power reported morbidity and mortality outcomes . None addressed quality of life or general well being issues . In general , participants assigned to weight-reduction groups lost weight compared to control groups . Six trials involving 361 participants assessed a weight-reducing diet versus a normal diet . The data suggested weight loss in the range of 4 % to 8 % of body weight was associated with a decrease in blood pressure in the range of 3 mm Hg systolic and diastolic . Three trials involving 363 participants assessed a weight-reducing diet versus treatment with antihypertensive medications . These suggested that a stepped-care approach with antihypertensive medications produced greater decreases in blood pressure ( in the range of 6/5 mm Hg systolic/diastolic ) than did a weight-loss diet . Trials that allowed adjustment of participants ' antihypertensive regimens suggested that patients required less intensive antihypertensive drug therapy if they followed a weight-reducing diet . Data was insufficient to determine the relative efficacy of weight-reduction versus changes in sodium or potassium intake or exercise . REVIEW ER 'S CONCLUSIONS : Weight-reducing diets in overweight hypertensive persons can affect modest weight loss in the range of 3 - 9 % of body weight and are probably associated with modest blood pressure decreases of roughly 3 mm Hg systolic and diastolic . Weight-reducing diets may decrease dosage requirements of persons taking antihypertensive medications OBJECTIVES --To improve blood pressure control among hypertensive ( > 140/90 mmHg ) excessive alcohol drinkers . DESIGN --Fourteen worksite physicians  were r and omised onto an intervention group and a control group . The intervention was based on training the worksite physicians and follow up of those hypertensive subjects defined as excessive drinkers . Follow up was based on self monitoring of alcohol consumption by the subject , in view of the results of their gamma glutamyl transferase ( GGT ) activity determination . SETTING --Fourteen workplaces in France - mainly in the industrial sector . SUBJECTS -- Altogether 15 301 subjects were screened by the 14 physicians : 129 of these were included in the study . MAIN OUTCOME MEASURES --This was the difference between the initial systolic blood pressure ( SBP ) and the SBP one year later ( delta BP ) . Secondary criteria were the difference between the initial and final diastolic blood pressure ( delta DBP ) and delta BP at two years ; antihypertensive treatment ; state alcohol consumption ( delta AC ) ; delta GGT ; and body mass index ( delta BMI ) . RESULTS --The decrease in SBP levels was significantly larger in the intervention group than in the control group : at one year , delta SBP values were -11.9 ( 15.6 ) mmHg and -4.6 ( 13.8 ) respectively ( p < 0.05 ) . This benefit was still observed after two years of follow up ( -13.8 ( 17.4 ) mmHg v -7.5 ( 14.2 ) mmHg ( p < 0.05 ) ) . No difference was observed in DBP . The percentage of treated subjects did not differ between groups . At one year , delta AC was larger in the intervention group ( -2.8 ( 5.2 ) U/d ) than in the control group ( -1.6 ( 3.4 ) ( p < 0.1 ) ) . delta GGT and delta BMI did not differ between the two groups . A weak positive correlation was observed between delta AC and delta SBP ( r = 0.16 ) . CONCLUSION --An intervention aim ed at the hypertensive excessive drinkers in a working population was found to be effective in reducing SBP on a long term basis ( two years ) . The mechanisms of reduction in alcohol consumption and improved drug compliance can not be ascertained in this pragmatic study . From a public health point of view , reducing the excess cardiovascular risk among a " hard to reach " population seems feasible with a strategy specifically design ed for this high risk group The potential antihypertensive effects after prolonged use of small doses of fish oils remain undefined . Therefore , we conducted a r and omized , double-blind , controlled crossover study comparing low doses of n-3 fatty acid supplementation with n-6 fatty acids on blood pressure in 33 subjects with mild hypertension . After a 6-week stabilization period , subjects ingested either 2.04 g/d of n-3 fatty acids or safflower oil ( 4.8 g/d of linoleic acid ) for 12 weeks , then crossed over to the alternative encapsulated oil for another 12 weeks , after a 4-week washout period . All antihypertensive drug therapy had been discontinued . For the combined data , there were significant reductions from pretreatment values for supine diastolic ( -2.4 mm Hg ) and sitting systolic ( -4.1 mm Hg ) blood pressure after fish oil ; no significant changes occurred after safflower oil control . Compared with safflower oil , fish oil supplementation was associated with a statistically significant reduction in mean supine diastolic blood pressure of 3.7 mm Hg ( 95 % confidence interval , -7.3 and 0.1 ) . Sitting diastolic and mean arterial pressures showed a sequence effect ; therefore , only the initial period was used in an analysis of their responses . There were significant decreases from pretreatment values for sitting diastolic ( -4.4 mm Hg ) , mean arterial ( -5.1 mm Hg ) , and systolic ( -6.5 mm Hg ) blood pressure after fish oil . The differences between groups after the 12-week period remained statistically significant for sitting diastolic and sitting mean arterial blood pressures . No adverse changes were noted in plasma levels of lipid-related measures Effects of progressive muscle relaxation ( PMR ) and of attention control were investigated in a prospect i ve r and omized trial of borderline or mild hypertensive patients . Both groups received placebo and had the same number of clinic return visits . After 22 weeks the average mean home BP in PMR decreased 3 mm Hg , whereas in controls BP increased 2 mm Hg . Progressive muscle relaxation had no significant effect on the clinic BP . The response to PMR was not uniform . Responders were characterized by faster heart rates and higher plasma norepinephrine levels . The responders also showed a decrease of anxiety scores during the trial . Progressive muscle relaxation is a time-consuming procedure . Blood pressure responses do not substantially exceed the placebo effects in unselected patients . However , relaxation may be suitable for young , anxious patients with mild hypertension who have a high resting sympathetic tone Twenty-one patients with essential hypertension were r and omly allocated to eight 1-hour sessions of meditation training , meditation plus biofeedback-aided relaxation , or a no-treatment control group . Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs , although overall reductions in blood pressure were not significantly greater in either program than in the control group . Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone . All patients practice d meditation regularly between training sessions : The amount of practice did not correlate with the amount of blood pressure reduction after training . On question naire measures of psychological symptoms and personality , sex differences emerged , with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms . In females , outward-directed hostility fell significantly and assertiveness increased after training , but in males , somatopsychic symptoms were unchanged A prospect i ve r and omised trial was carried out to see whether paranormal healing by laying on of h and s might reduce blood pressure in essential hypertension and whether such an effect might be due to a paranormal , psychological , or placebo factor . Patients were r and omised to three treatment groups : paranormal healing by laying on of h and s ( n=40 )  , paranormal healing at a distance ( n=37 ) , and no paranormal healing ( controls ; n=38 ) .  Healing at a distance and no paranormal healing were investigated double blind . Systolic and diastolic blood pressures were significantly reduced in all three groups at week 15 ( mean reduction ( 95 % confidence interval ) 17·1 ( 14·0 to 20·2)/8·3 ( 6·6 to 10·0 ) mm Hg ) . Only the successive reductions in diastolic blood pressures among the groups from week to week were significantly different . Each week diastolic pressure was consistently lower ( average 1·9 mm Hg ) after healing at a distance compared with control , but on paired comparison these differences were not significant . Probably week to week variations among the groups accounted for any differences noted . In this study no treatment was consistently better than another and the data can not therefore be taken as evidence of a paranormal effect on blood pressure . Probably the fall in blood pressure in all three groups either was caused by the psychosocial approach or was a placebo effect of the trial itself Ninety patients with essential hypertension were followed for 5 years . Initially the patients were r and omized into two groups : ( a ) an  experimental group consisting of  44 patients who received autogenic training and ( b ) a  control group of 46 patients who did not receive any behavioral intervention .  By the end of the follow-up period , the experimental group was significantly different from the control group , with reduced blood pressure ( by 5.8 mm Hg systolic and 3.2 mm Hg diastolic vs. 4.3 mm Hg systolic and 2.0 mm Hg diastolic ) , a smaller increase in left-ventricular myocardial mass ( 14.6 g vs. 38.2 g ) , improved psychological indices , and a decrease in the number of sick days of leave .  Autogenic training appeared to be more effective in patients with mild hypertension than in those with moderate hypertension and the results were comparable with those obtained with regular medication To see whether general practitioners could effectively carry out training in relaxation and management of stress to reduce mild hypertension a study was carried out with a sub sample of phase 2 of the Medical Research Council 's treatment of mild hypertension trial.1 In the main mild hypertension trial patients had been receiving either an active drug or placebo for six years . In phase 2 a sub sample of these patients were r and omly allocated either to continue or to stop receiving the active drug or placebo . In a further sub sample patients were again r and omised to receive or not to receive relaxation therapy . This factorial design presented an additional opportunity to assess whether patients controlled with active drugs might have their blood pressure maintained by this behavioural therapy once drug treatment was stopped and to assess whether blood pressure might be further reduced by this therapy in patients who had been under regular medical supervision for as long as six years and who had already received non-pharmacological advice . The therapy was conducted by general practitioners in group sessions once a week for eight weeks . The training in relaxation was accompanied by galvanic skin resistance biofeedback . At one year follow up blood pressure in the relaxation subgroups was either maintained ( in the group who had stopped receiving drugs ) or reduced further ( in the group who had continued receiving drugs and in both placebo groups ) , while in the control group it had increased in all the subgroups , but particularly in those who had stopped receiving drugs . Differences in changes in blood pressure between the relaxation and control groups were significant . There were five new cardiovascular events , including evidence of myocardial ischaemia in blindly coded electrocardiograms in the control group , compared with one in the treatment group . General practitioners , if motivated , can successfully apply this technique of training those with mild hypertension in relaxation and management of stress Twenty-one patients with essential hypertension were treated with aerobic ( lactate threshold ) exercise ( n = 21 ) and the change in blood pressure was compared with that in a non-exercising hypertensive control group ( n = 10 ) . After 10 weeks of exercise therapy blood pressure in the exercise group was significantly reduced , from 154 ± 3/100 ± 2 to 141 ± 3/93 ± 3 mmHg , and there was a significant reduction in plasma volume , cardiac index and plasma noradrenaline whereas there were no changes in the non-exercise group . Responders ( 10 mmHg or more fall in mean blood pressure ) in the exercise group had a significantly higher cardiac index , serum Na : K ratio and lower total peripheral resistance in pretraining studies than non-responders . In conclusion , exercise at lactate threshold is effective in lowering blood pressure in those mild hypertensives with higher cardiac index and serum Na : K ratio 1 . Three groups of young patients with borderline hypertension were studied for a 12 months period . The first was on a free sodium diet while the second was on a low-salt diet . The third group of patients underwent acute salt loading . 2 . After 12 months the group on free diet showed a significant increase of intralymphocytic sodium but no change in blood pressure was noted . Five patients who were re-checked after 24 months also had a significant increase in blood pressure . 3 . Patients treated with a low-salt diet showed a significant decrease of both intralymphocytic sodium concentration and blood pressure . 4 . After acute salt loading , borderline subjects with high intralymphocytic sodium showed a significant greater natriuresis whereas intralymphocytic sodium increased only in those subjects in whom it was initially normal We examined 117 out patients ( 20- to 45-year-old men ) with mild essential hypertension before treatment , after the main treatment course ( 6 weeks ) , and at 12-month follow-up . The patients were r and omized into two major groups : ( a ) a treatment group that received autogenic training ( 23 patients ) , biofeedback ( 24 patients ) , or breathing-relaxation training ( 23 patients ) and ( b ) a control group that consisted of 24 patients who did not receive any intervention and 23 patients who were treated with a " psychological placebo . " Clinical , psychological , and psychophysiological data from all patients who were offered relaxation therapy were analyzed . By the end of follow-up , and compared to the control group , the treatment group demonstrated a significant reduction in systolic and diastolic blood pressures , peripheral vascular resistance , and hypertensive response to emotional stress , and an improvement in psychological adaptation , quality of life , and capacity for work . Comparative analysis of the efficacy of different relaxation methods revealed that biofeedback and breathing-relaxation training result ed in the greatest reduction in blood pressure . The antihypertensive effect of relaxation therapy correlated positively with pretreatment blood pressure levels and negatively with the duration of illness and certain psychological features We used 24-h monitoring of blood pressure ( BP ) to evaluate the effect of calcium supplementation on mild to moderate essential hypertension in elderly hospitalized patients for the first time in a controlled crossover study . The mean systolic and diastolic BP over a period of 24 h declined by 13.6 mm Hg ( P less than .005 ) and 5.0 mm Hg ( P less than .05 ) respectively in patients whose diet was supplemented with 1 g of elemental calcium in the form of oystershell electrolysate ( AA calcium ) .  Serum ionized calcium and urinary calcium and sodium excretion increased ( serum Ca2 + 0.16 + /- 0.03 mEq/L , P less than .05 ; FECa 0.5 + /- 0.2 % , P less than .05 ; FENa 0.4 + /- 0.1 % , P less than .05 ) and plasma parathyroid hormone was suppressed ( 12.2 + /- 2.3 pg/mL , P less than .005 ) . These data suggest that supplementation of dietary calcium may contribute to a reduction of BP in elderly patients with essential hypertension The purpose of this study was to investigate the effect of 1-year diet intervention , exercise intervention and both combined on blood pressure ( BP ) in normotensives and mild hypertensives . Two hundred and nineteen sedentary middle aged men and women with slightly deranged coronary heart disease ( CHD ) risk factors were r and omised to a control , a diet , an exercise and a diet + exercise group . Based on baseline diastolic BP , participants were divided into tertiles , giving baseline average BP of 141.4/96.7 in tertile 1 , 130.7/87.6 in tertile 2 and 121.9/79.0 in tertile 3 . The 1-year net-difference in BP between the intervention groups and the control group decreased across the tertiles ; in tertile 1 being -11.2/-6.7 ( p < 0.05 ) , -11.3/-6.7 ( p < 0.05 for systolic BP only ) and -7.0/-5.1 ( NS ) in the combined , diet and exercise group respectively . Triglycerides , HDL cholesterol , and insulin variables were significantly and favourably changed , the changes being most marked in the combined group . The results show that diet and diet + exercise are about equally effective in reducing BP , and the effects may be dependent on the baseline level . Within the upper tertile of baseline BP , the decline in BP in the combined intervention and the diet group are almost comparable to those obtained with drug treatment . In addition , other important CHD risk factors were all changed in a beneficial direction BACKGROUND Lifestyle modifications , such as physical activity , are recommended as first-line or adjunctive therapy for hypertension . However , controversy exists regarding the type , amount , and intensity of physical activity for optimal blood pressure lowering . DESIGN AND METHODS This study evaluated the blood pressure changes in 18 post-menopausal , sedentary , untreated hypertensive women r and omized to an individualized 8-week programme of intermittent moderate-intensity physical activity versus no change in physical activity . The physical activity group was asked to select activities ( such as walking ) to engage in physical activity for 10 min , three times a day , 5 days per week at an intensity of 50 - 60 % heart rate reserve . RESULTS Independent T-tests were used to compare the difference in resting blood pressure between groups . After 8 weeks , resting blood pressure was 8/5 mmHg lower in the physical activity group ( systolic blood pressure , P= 0.006 and diastolic blood pressure , P = 0.059 ) . The between group differences remained significant after adjustment for age , baseline blood pressure and previous use of antihypertensive drug therapy . CONCLUSION These data show that hypertensive , post-menopausal women who engage in intermittent , moderate-intensity physical activity experience a reduction in blood pressure Unmedicated mildly hypertensive Type A men were r and omly allocated to one of three conditions : stress management intervention training ( N = 15 ) , Type A management ( N = 15 ) , and delayed Type A management intervention . Significantly greater reductions in blood pressure at rest and during the Type A structured interview were found following the active interventions than during the minimal treatment control period of the delayed intervention . Type A management was more successful in changing a number of Type A behaviours , including anger , hostility and global Type A behaviour . Changes on measures of anger-in , -out , hostility , and SI ratings of Type A behaviour were associated with changes in systolic and diastolic blood pressure reactivity during interview 1 . The effect of oral magnesium supplementation was assessed in a group of untreated , mild hypertensive subjects who were following a moderately low sodium diet ( baseline urinary sodium 86 ± 6 mmol/day ) This was a r and omized and double-blind study to examine : ( 1 ) the effect of a 1500 mg/day calcium supplement vs a placebo for 8 wk in 42 adults with high normal or mildly elevated blood pressure ( BP ) and , ( 2 ) the relationship between baseline serum total calcium levels and BP response to calcium supplementation . Following the experimental protocol , mean pressures were lower in the treatment vs placebo group ( 95.7 mmHg and 102.1 mmHg , p = 0.002 ) , but response was not related to initial serum total calcium levels . After 8 wk of calcium supplementation , serum total calcium was greater in the treatment group compared to the placebo group ( p = 0.02 ) . Within the treatment group only , the change in total serum calcium was related to the change in parathyroid hormone ( r = -0.92 , p = 0.0002 ) ; and the change in ionized calcium was related to the change in parathyroid hormone ( r = -0.68 , p = 0.03 ) in the subgroup with low baseline serum total calcium . This study provides further support for the hypotensive effect of supplemental calcium in some people . However , it fails to clarify or exp and upon previous reports that a low serum total calcium level might be predictive of the blood pressure response to increased calcium It has been cl aim ed that calcium lowers BP . The present r and omised , double-blind , placebo-controlled crossover study is the first to investigate the effect on BP of a high oral dose of calcium given for a long period to patients with previously untreated hypertension .  Elemental calcium ( 2 g ) was administered for 12 weeks interchanging with a period of 12 weeks of placebo .  Twenty patients completed the protocol . There was no significant difference in change of BP during the period of additional calcium intake when compared with placebo ( P = 0.33 ) . The risk of not detecting a real BP-lowering effect of calcium of at least 3 mmHg was < 5 % . No evidence for the existence of a subgroup of ' responders ' was found . It is concluded that a high daily dose of calcium supplementation given for 12 weeks does not decrease BP in previously untreated patients with mild to moderate hypertension Thirty subjects with essential hypertension were assigned r and omly to either a no treatment control , education , or education with relaxation training group . Independent blood pressure recordings were collected by medical staff at pretest , posttest , and 8-week follow-up . Results suggest a significant interaction between treatment and time for the dependent physiological measure , systolic blood pressure . During the pretest to follow-up period , the control group averaged a 5.9 mm . Hg . increase , the education with relaxation group an 8.8 mm . Hg . decrease , and the education group a 14.9 mm . Hg . decrease in systolic blood pressure . There was no significant difference in group means for diastolic blood pressure within groups over time . As measured at follow-up , education appeared more effective in reducing systolic blood pressure than education with relaxation training . More than one-third of subjects associated unpleasant side effects with their antihypertensive medication . Almost all treatment subjects rated the education and relaxation as helpful for underst and ing and managing their hypertension OBJECTIVE --To determine the long term effects of relaxation therapy on 24 hour ambulatory intra-arterial blood pressure in patients with mild untreated and uncomplicated hypertension . DESIGN --Four week screening period followed by r and omisation to receive either relaxation therapy or non-specific counselling for one year . Ambulatory intra-arterial blood pressure was measured before and after treatment . SETTING --Outpatient clinic in Amsterdam 's university hospital . SUBJECTS--35 Subjects aged 20 - 60 who were being treated by general practitioners for hypertension but were referred to take part in the study . At three consecutive screening visits all subjects had a diastolic blood pressure without treatment of 95 - 110 mm Hg . Subjects were excluded if they had damaged target organs , secondary hypertension , diabetes mellitus , a cholesterol concentration greater than 8 mmol/l , or a history of malignant hypertension . INTERVENTIONS --The group allocated to relaxation therapy was trained for eight weeks ( one hour a week ) in muscle relaxation , yoga exercises , and stress management and continued exercising twice daily for one year with monthly visits to the clinic . The control group had the same attendance schedule but had no training and were requested just to sit and relax twice a day . All subjects were asked not to change their diet or physical activity . MAIN OUTCOME MEASURE -- Changes in ambulatory intra-arterial blood pressure after one year of relaxation therapy or non-specific counselling . RESULTS --Mean urinary sodium excretion , serum concentration of cholesterol , and body weight did not change in either group . Diastolic pressures measured by sphygmomanometry were 2 and 3 mm Hg lower in subjects in the relaxation group and control group respectively at the one year follow up compared with initial readings . The mean diastolic ambulatory intra-arterial pressure during the daytime had not changed after one year in either group , but small treatment effects could not be excluded : the mean change for the relaxation group was -1 mm Hg ( 95 % confidence interval -6 to 3.9 mm Hg ) and for the control group -0.4 mm Hg ( -5.3 to 4.6 mm Hg ) . Mean ambulatory pressure in the evening also had not changed over the year , and in both groups nighttime pressure was 5 mm Hg higher . The variability in blood pressure was the same at both measurements . CONCLUSIONS --Relaxation therapy was an ineffective method of lowering 24 hour blood pressure , being no more beneficial than non-specific advice , support , and reassurance -- themselves ineffective as a treatment for hypertension In this study eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) were given in a cumulative manner , every 6 weeks , starting with 10 mg , then 100 mg , 1000 mg and 10,000 mg EPA daily to mild to moderate essential hypertensive black patients . The corresponding DHA doses were 3 , 33 , 333 and 3333 mg . A control group was given olive oil as placebo for the entire 24 weeks . The placebo group had lower diastolic and systolic blood pressures after 24 weeks than the EPA and DHA group . No effect was seen on plasma triglycerides , cholesterol , HDL-cholesterol and gamma-glutamyltranspeptidase at any stage of the trial . In the EPA group plasma free-EPA increased significantly from 1000 mg onwards and plasma free-arachidonic acid ( AA ) decreased after 1000 mg EPA . No other plasma free essential fatty acid changed during the trial , although the HDL : cholesterol increased slightly but non-significantly with an increase in EPA and DHA . No significant changes in diet pattern or body mass was observed . It is therefore concluded that EPA and DHA supplementation had no beneficial effects in mild to moderate essential hypertensive black patients except for a lowering of plasma AA In the first of two studies , 42 unmedicated mild hypertensives completed either 16 sessions of thermal biofeedback ( TBF ) training for h and ( 7 sessions ) and foot ( 9 sessions ) warming or 8 weeks of monitoring BPs at home . There was a trend ( p<.10 ) for more of those treated ( 57.1 % ) to have DBPs lower than 90 mm Hg than for those only monitoring BPs at home ( 33 % ) . Analyses of clinic BP values from r and om zero sphygmomanometer measurements , from 24-hour ambulatory BP monitoring , and from home  BP measurements made by the patient showed no advantage for treatment versus BP monitoring . Sixteen of the 21 patients in BP monitoring were later treated . Analyses of treatment effects across all treated subjects by gender revealed a significant ( p=.02 ) decrease in DBP for treated female subjects ( n=13 ) but not for males ( n=24 ) . In the second study the 22 initial treatment successes , that is , those whose DBP was below 90 mm Hg at posttreatment ( 59.4 % of those who completed treatment ) , were r and omized to an intensive follow-up ( monthly visits for 6 months , then visits every two months ) emphasizing regular home practice with an electronic TBF device or regular follow-up ( visits every 3 months ) . Twelve of the 22 were still normotensive at 12 months . There were no differences at any point during the follow-up between the two conditions in success rate or BPs despite a numerical advantage in reported frequency of home practice by those in the intensive follow-up condition Both n-3 and n-6 polyunsaturated fats have been suggested to lower blood pressure , an effect ascribed to altered bio synthesis of eicosanoids . To test these hypotheses , we studied blood pressure and eicosanoid production during supplementation of dietary fat for four weeks in 32 men with mild essential hypertension . Supplementation was preceded and followed by four-week run-in and recovery periods . Groups of eight subjects received either 10 ml or 50 ml of fish oil ( 3 or 15 g of n-3 fatty acids ) daily , 50 ml of safflower oil ( 39 g of n-6 fatty acids ) , or 50 ml of a mixture of oils that approximated the types of fat present in the American diet . The bio synthesis of eicosanoids was assessed by the measurement of urinary metabolites . Blood pressure decreased in the men who received the high dose of fish oil ( systolic pressure by a mean of 6.5 mm Hg [ P less than 0.03 ] and diastolic pressure by 4.4 mm Hg [ P less than 0.015 ] ) , but not in the other groups . Although the formation of vasodilatory prostacyclins ( prostagl and ins I2 and I3 ) increased initially , this increase was not maintained as blood pressure fell . The level of thromboxane A2 metabolites fell ; metabolites of thromboxane A3 were detected in the groups receiving fish oil . The formation of prostagl and in E2 increased during supplementation with safflower oil and tended to decrease with fish oil ; no prostagl and in E3 metabolite was detected . Our data indicate that high doses of fish oil can reduce blood pressure in men with essential hypertension . However , the clinical usefulness and safety of fish oil in the treatment of hypertension will require further study Studies of whether polyunsaturated fatty acids in fish oil -- in particular , eicosapentaenoic and docosahexaenoic acids -- lower blood pressure have varied in design and results . We conducted a population -based , r and omized , 10-week dietary-supplementation trial in which the effects of 6 g per day of 85 percent eicosapentaenoic and docosahexaenoic acids were compared with those of 6 g per day of corn oil in 156 men and women with previously untreated stable , mild essential hypertension . The mean systolic blood pressure fell by 4.6 mm Hg ( P = 0.002 ) , and diastolic pressure by 3.0 mm Hg ( P = 0.0002 ) in the group receiving fish oil ; there was no significant change in the group receiving corn oil . The differences between the groups remained significant for both systolic ( 6.4 mm Hg ; P = 0.0025 ) and diastolic ( 2.8 mm Hg ; P = 0.029 ) pressure after control for anthropometric , lifestyle , and dietary variables . The decreases in blood pressure were larger as concentrations of plasma phospholipid n-3 fatty acids increased ( P = 0.027 ) . Dietary supplementation with fish oil did not change mean blood pressure in the subjects who ate fish three or more times a week as part of their usual diet , or in those who had a base-line concentration of plasma phospholipid n-3 fatty acids above 175.1 mg per liter . We conclude that eicosapentaenoic and docosahexaenoic acids reduce blood pressure in essential hypertension , depending on increases in plasma phospholipid n-3 fatty acids Employees of a large industry were screened for the presence of coronary risk factors . A total of 204 employees , aged 35 - 64 years , with two or more such factors ( serum cholesterol concentration greater than or equal to 6.3 mmol/l ( 243.6 mg/100 ml ) , blood pressure greater than or equal to 140/90 mm Hg , and current cigarette consumption greater than or equal to 10 cigarettes a day ) were r and omly allocated to a biofeedback group receiving training in relaxation and management of stress or a control group . Both groups received simple health education literature . After eight weeks of training , and again eight months later , the biofeedback group showed a significantly greater fall in systolic and diastolic blood pressures than the control group ( p less than 0.001 ) . Plasma renin activity and plasma aldosterone concentration were measured in a sub sample at entry to the study and again at eight weeks and eight months ; both showed a greater reduction in the biofeedback compared with the control group at eight weeks ' follow-up . The greater reduction in blood pressure in the subjects in the biofeedback group compared with the control group ( 11.0 mm Hg systolic and 8.8 mm Hg diastolic ) , persisting eight months after the training , suggests that relaxation-based behavioural methods might be offered as a first-time treatment to patients with mild hypertension & NA ; This study tested the efficacy of relaxation therapy as sole treatment for mild hypertension in 110 men and women recruited from a five‐stage worksite blood pressure screening program . Participants were r and omized to 12‐weeks of relaxation therapy or support therapy .  Outcome blood pressure assessment s made by assessors who were unaware of group allocation revealed similar decreases in both treatment groups at post‐treatment and 6‐month follow‐up . While body weight did not change , alcohol consumption decreased similarly in both groups , and alcohol consumption was positively correlated with both absolute diastolic blood pressure and change in diastolic blood pressure at outcome . In conclusion , a superior blood pressure effect was not associated with relaxation therapy ;  however , alcohol consumption decreased in both treatment groups , suggesting that both interventions facilitated changes in health risk behaviors and indirectly on blood pressure level OBJECTIVE To determine whether provision of individualised physical activity advice by an exercise specialist in general practice is effective in modifying physical activity and cardiovascular risk factors  in older adults . DESIGN R and omised controlled trial of individualised physical activity advice , reinforced at three and six months ( intervention ) versus no advice ( control ) . SETTING Two general practice s in Adelaide , South Australia , 1996 . PARTICIPANTS 299 adults aged 60 years or more who were healthy , sedentary and living in the community . MAIN OUTCOME MEASURES Changes to physical activity ( frequency and duration of walking and vigorous exercise ) , selected cardiovascular risk factors ( blood pressure , body weight , serum lipid levels ) and quality of life over 12 months . RESULTS Self-reported physical activity increased over the 12 months in both groups ( P < 0.001 ) . The increase was greater for the intervention than the control group for all measures except time spent walking ( P < 0.05 ) . More intervention than control participants increased their intention to exercise ( P < 0.001 ) . Serum levels of total and low-density lipoprotein cholesterol and triglycerides fell significantly over the 12 months to a similar extent in the two groups . No other significant changes in cardiovascular risk factors were seen . Quality -of-life scores decreased over the 12 months . The decrease was significantly greater among intervention than control women , but not men , for emotional well-being ( P = 0.02 ) , physical well-being ( P = 0.04 ) and social functioning ( P = 0.04 ) . DISCUSSION Provision of general practice -based physical activity advice reinforced three-monthly produced a sustained increase in self-reported physical activity . However , there were no associated changes in clinical measures of cardiovascular risk factors and minimal changes in quality -of-life measures
target: Robust statistically significant effects were found for improved diet , aerobic exercise , alcohol and sodium restriction , and fish oil supplements : mean reductions in systolic blood pressure of 5.0 mmHg [ 95 % confidence interval ( CI ) : 3.1 - 7.0 ] , 4.6 mmHg ( 95 % CI : 2.0 - 7.1 ) , 3.8 mmHg ( 95 % CI : 1.4 - 6.1 ) , 3.6 mmHg ( 95 % CI : 2.5 - 4.6 ) and 2.3 mmHg ( 95 % CI : 0.2 - 4.3 ) , respectively , with corresponding reductions in diastolic blood pressure .
  Relaxation significantly reduced blood pressure only when compared with non-intervention controls .
  We found no robust evidence of any important effect on blood pressure of potassium , magnesium or calcium supplements .
  Available evidence does not support relaxation therapies , calcium , magnesium or potassium supplements to reduce blood pressure
background: PURPOSE To quantify effectiveness of lifestyle interventions for hypertension .