长期体重减轻与血压变化：高血压预防试验二期结果

Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II.

作者信息

Stevens V J, Obarzanek E, Cook N R, Lee I M, Appel L J, Smith West D, Milas N C, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Raczynski J, Brewer A, Singh B, Cohen J

机构信息

Kaiser Permanente Center for Health Research, Portland, Oregon 97227, USA.

出版信息

Ann Intern Med. 2001 Jan 2;134(1):1-11. doi: 10.7326/0003-4819-134-1-200101020-00007.

DOI:10.7326/0003-4819-134-1-200101020-00007

PMID:11187414

Abstract

BACKGROUND

Weight loss appears to be an effective method for primary prevention of hypertension. However, the long-term effects of weight loss on blood pressure have not been extensively studied.

OBJECTIVE

To present detailed results from the weight loss arm of Trials of Hypertension Prevention (TOHP) II.

DESIGN

Multicenter, randomized dinical trial testing the efficacy of lifestyle interventions for reducing blood pressure over 3 to 4 years. Participants in TOHP II were randomly assigned to one of four groups. This report focuses only on participants assigned to the weight loss (n = 595) and usual care control (n = 596) groups.

PATIENTS

Men and women 30 to 54 years of age who had nonmedicated diastolic blood pressure of 83 to 89 mm Hg and systolic blood pressure less than 140 mm Hg and were 110% to 165% of their ideal body weight at baseline.

INTERVENTION

The weight loss intervention included a 3-year program of group meetings and individual counseling focused on dietary change, physical activity, and social support

MEASUREMENTS

Weight and blood pressure data were collected every 6 months by staff who were blinded to treatment assignment

RESULTS

Mean weight change from baseline in the intervention group was -4.4 kg at 6 months, -2.0 kg at 18 months, and -0.2 kg at 36 months. Mean weight change in the control group at the same time points was 0.1, 0.7, and 1.8 kg. Blood pressure was significantly lower in the intervention group than in the control group at 6, 18, and 36 months. The risk ratio for hypertension in the intervention group was 0.58 (95% CI, 0.36 to 0.94) at 6 months, 0.78 (CI, 0.62 to 1.00) at 18 months, and 0.81 (CI, 0.70 to 0.95) at 36 months. In subgroup analyses, intervention participants who lost at least 4.5 kg at 6 months and maintained this weight reduction for the next 30 months had the greatest reduction in blood pressure and a relative risk for hypertension of 0.35 (CI, 0.20 to 0.59).

CONCLUSIONS

Clinically significant long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss.

摘要

背景

体重减轻似乎是原发性高血压一级预防的有效方法。然而，体重减轻对血压的长期影响尚未得到广泛研究。

目的

展示高血压预防试验（TOHP）II中体重减轻组的详细结果。

设计

多中心随机临床试验，测试生活方式干预在3至4年内降低血压的疗效。TOHP II的参与者被随机分配到四组中的一组。本报告仅关注分配到体重减轻组（n = 595）和常规护理对照组（n = 596）的参与者。

患者

年龄在30至54岁之间的男性和女性，基线时非药物治疗的舒张压为83至89 mmHg，收缩压低于140 mmHg，体重为理想体重的110%至165%。

干预措施

体重减轻干预包括一个为期3年的项目，通过小组会议和个人咨询，重点关注饮食变化、体育活动和社会支持。

测量

由对治疗分配不知情的工作人员每6个月收集一次体重和血压数据。

结果

干预组从基线开始的平均体重变化在6个月时为-4.4 kg，18个月时为-2.0 kg，36个月时为-0.2 kg。对照组在相同时间点的平均体重变化分别为0.1 kg、0.7 kg和1.8 kg。在6个月、18个月和36个月时，干预组的血压显著低于对照组。干预组6个月时高血压的风险比为0.58（95%CI，0.36至0.94），18个月时为0.78（CI，0.62至1.00），36个月时为0.81（CI，0.70至0.95）。在亚组分析中，6个月时体重减轻至少4.5 kg并在接下来30个月保持体重减轻的干预参与者血压降低幅度最大，高血压相对风险为0.35（CI，0.20至0.59）。