You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 151 No. 7, JULY 1991 TABLE OF CONTENTS
  Archives
  •  Online Features
  ORIGINAL INVESTIGATIONS
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (90)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

The Treatment of Mild Hypertension Study

A Randomized, Placebo-Controlled Trial of a Nutritional-Hygienic Regimen Along With Various Drug Monotherapies

The Treatment of Mild Hypertension Research Group

Arch Intern Med. 1991;151(7):1413-1423.


Abstract

There is no consensus for the optimal treatment program for individuals with mild hypertension, including whether treatment should emphasize life-style changes alone, such as weight loss, reduction of sodium and alcohol intake, and increased physical activity, or whether it should also include a pharmacologic component. The dilemma is accentuated by the availability of many drugs from different classes to lower blood pressure. To study the relative efficacy and safety of a combination of pharmacologic and nutritional-hygienic intervention compared with nutritional-hygienic intervention alone, a double-blind, controlled clinical trial was initiated. Nine hundred two men and women with mild hypertension (average blood pressure, 140/91 mm Hg) were randomized to receive nutritional-hygienic intervention plus one of six treatments: (1) placebo; (2) diuretic (chlorthalidone); (3) β-blocker (acebutolol); (4) {alpha}1-antagonist (doxazosin mesylate); (5) calcium antagonist (amlodipine maleate); or (6) angiotensin-converting enzyme inhibitor (enalapril maleate). After 12 months, weight loss averaged 4.5 kg, urinary sodium excretion was reduced by 23%, and reported leisure-time physical activity was nearly doubled. Systolic and diastolic blood pressure in the group given nutritional-hygienic intervention alone (placebo) were reduced by 10.6 and 8.1 mm Hg, respectively. For participants in the five groups receiving antihypertensive medication inaddition to nutritional-hygienic treatment, blood pressure reductions were significantly greater than those achieved with nutritional-hygienic treatment alone (range, 16 to 22 mm Hg for systolic and 12 to 14 mm Hg for diastolic blood pressure). Although differences among treatment groups in certain dimensions of quality of life, self-reported side effects, plasma lipid levels, and biochemical measures were observed, no consistent pattern in the differences was noted. Nutritional-hygienic therapy is an effective first-step treatment for persons with mild hypertension, and significant additional blood pressure lowering with minimal short-term side effects can be achieved by adding one of five different classes of antihypertensive agents.

(Arch Intern Med. 1991;151:1413-1423)



Author Affiliations

From the Treatment of Mild Hypertension Research Group, University of Minnesota, Minneapolis.


Footnotes

Accepted for publication January 22, 1991.

Reprint requests to Coordinating Centers for Biometric Research, Division of Biostatistics, School of Public Health, University of Minnesota, Room 200, 2221 University Ave SE, Minneapolis, MN 55414 (James D. Neaton, PhD).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Milk Products, Dietary Patterns and Blood Pressure Management
Kris-Etherton et al.
J. Am. Coll. Nutr. 2009;28:103S-119S.
ABSTRACT | FULL TEXT  

Blood Pressure and Risk of Death from External Causes among Men Screened for the Multiple Risk Factor Intervention Trial
Terry et al.
Am J Epidemiol 2007;165:294-301.
ABSTRACT | FULL TEXT  

Masterclass series in peripheral arterial disease: Hypertension and peripheral arterial disease
Olin
Vasc Med 2005;10:241-246.
 

Weight Loss in Overweight Adults and the Long-term Risk of Hypertension: The Framingham Study
Moore et al.
Arch Intern Med 2005;165:1298-1303.
ABSTRACT | FULL TEXT  

Erectile dysfunction: a need for greater awareness
Lau et al.
The Journal of the Royal Society for the Promotion of Health 2004;124:214-216.
ABSTRACT  

The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke et al.
Psychosom. Med. 2002;64:258-266.
ABSTRACT | FULL TEXT  

Nonspecific Medication Side Effects and the Nocebo Phenomenon
Barsky et al.
JAMA 2002;287:622-627.
ABSTRACT | FULL TEXT  

Calcium Modulation of Hypertension and Obesity: Mechanisms and Implications
Zemel
J. Am. Coll. Nutr. 2001;20:428S-435.
ABSTRACT | FULL TEXT  

DASH (Dietary Approaches to Stop Hypertension) Diet Is Effective Treatment for Stage 1 Isolated Systolic Hypertension
Moore et al.
Hypertension 2001;38:155-158.
ABSTRACT | FULL TEXT  

Studying Symptoms: Sampling and Measurement Issues
Kroenke
ANN INTERN MED 2001;134:844-853.
ABSTRACT | FULL TEXT  

Hypothesis: {beta}-Adrenergic Receptor Blockers and Weight Gain : A Systematic Analysis
Sharma et al.
Hypertension 2001;37:250-254.
ABSTRACT | FULL TEXT  

Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet
Sacks et al.
NEJM 2001;344:3-10.
ABSTRACT | FULL TEXT  

The Urgent Need to Improve Hypertension Care
Trilling and Froom
Arch Fam Med 2000;9:794-801.
ABSTRACT | FULL TEXT  

The Rapidity of Drug Dose Escalation Influences Blood Pressure Response and Adverse Effects Burden in Patients With Hypertension: The Quinapril Titration Interval Management Evaluation (ATIME) Study
Flack et al.
Arch Intern Med 2000;160:1842-1847.
ABSTRACT | FULL TEXT  

Headache in Mild-to-Moderate Hypertension and Its Reduction by Irbesartan Therapy
Hansson et al.
Arch Intern Med 2000;160:1654-1658.
ABSTRACT | FULL TEXT  

Reducing Antihypertensive Medication Use in Nursing Home Patients
Froom and Trilling
Arch Fam Med 2000;9:378-383.
ABSTRACT | FULL TEXT  

Effects of Stress Reduction on Carotid Atherosclerosis in Hypertensive African Americans
Castillo-Richmond et al.
Stroke 2000;31:568-573.
ABSTRACT | FULL TEXT  

Current and Potential Drugs for Treatment of Obesity
Bray and Greenway
Endocr. Rev. 1999;20:805-875.
ABSTRACT | FULL TEXT  

Finding Consensus in the Dietary Calcium-Blood Pressure Debate
McCarron and Reusser
J. Am. Coll. Nutr. 1999;18:398S-405.
ABSTRACT | FULL TEXT  

Systematic review of antihypertensive therapies: Does the evidence assist in choosing a first-line drug?
Wright et al.
CMAJ 1999;161:25-32.
ABSTRACT | FULL TEXT  

Rationale and design of the International Verapamil SR/Trandolapril Study (INVEST): an Internet-based randomized trial in coronary artery disease patients with hypertension
Pepine et al.
J Am Coll Cardiol 1998;32:1228-1237.
ABSTRACT | FULL TEXT  

Joint British recommendations on prevention of coronary heart disease in clinical practice
British Cardiac Society et al.
Heart 1998;80:1S-29.
FULL TEXT  

Quality of life in chronic heart failure: cilazapril and captopril versus placebo
Bulpitt et al.
Heart 1998;79:593-598.
ABSTRACT | FULL TEXT  

A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure
Appel et al.
NEJM 1997;336:1117-1124.
ABSTRACT | FULL TEXT  

Relationships of Quality-of-Life Measures to Long-term Lifestyle and Drug Treatment in the Treatment of Mild Hypertension Study
Grimm et al.
Arch Intern Med 1997;157:638-648.
ABSTRACT  

Different Concepts in First-Line Treatment of Essential Hypertension: Comparison of a Low-Dose Reserpine-Thiazide Combination With Nitrendipine Monotherapy
Kronig et al.
Hypertension 1997;29:651-658.
ABSTRACT | FULL TEXT  

Hypertension Education: An Important and Neglected Part of the Diabetes Education Curriculum?
Hinson et al.
The Diabetes Educator 1997;23:166-170.
 

Long-term Effects on Sexual Function of Five Antihypertensive Drugs and Nutritional Hygienic Treatment in Hypertensive Men and Women: Treatment of Mild Hypertension Study (TOMHS)
Grimm et al.
Hypertension 1997;29:8-14.
ABSTRACT | FULL TEXT  

Long-term Effects on Plasma Lipids of Diet and Drugs to Treat Hypertension
Grimm et al.
JAMA 1996;275:1549-1556.
ABSTRACT  

Efficacy and Tolerance of Antihypertensive Treatment in Men and Women With Stage 1 Diastolic Hypertension: Results of the Treatment of Mild Hypertension Study
Lewis et al.
Arch Intern Med 1996;156:377-385.
ABSTRACT  

Comparison of Early and Late Start of Antihypertensive Agents and Baroreceptor Reflexes
Kumagai et al.
Hypertension 1996;27:209-218.
ABSTRACT | FULL TEXT  

Use of Antihypertensive Drugs and Trends in Blood Pressure in the Elderly
Glynn et al.
Arch Intern Med 1995;155:1855-1860.
ABSTRACT  

Detection of Effects on Male Reproduction--A Literature Survey
Ulbrich and Palmer
International Journal of Toxicology 1995;14:293-327.
ABSTRACT  

Nutritional Factors and Hypertension
Lardinois
Arch Fam Med 1995;4:707-713.
ABSTRACT  

Trends in Pharmacologic Management of Hypertension in the United States
Manolio et al.
Arch Intern Med 1995;155:829-837.
ABSTRACT  

Ambulatory Blood Pressure Monitoring: Quality Assurance-Reply
Moser
Arch Intern Med 1995;155:549-549.
ABSTRACT  

Comparison of Five Antihypertensive Monotherapies and Placebo for Change in Left Ventricular Mass in Patients Receiving Nutritional-Hygienic Therapy in the Treatment of Mild Hypertension Study (TOMHS)
Liebson et al.
Circulation 1995;91:698-706.
ABSTRACT | FULL TEXT  

Feasibility Study of N-of-1 Trials With Blood Pressure Self-Monitoring in Hypertension
Chatellier et al.
Hypertension 1995;25:294-301.
ABSTRACT | FULL TEXT  

Hypertension in the Elderly: Implications and Generalizability of Randomized Trials
Mulrow et al.
JAMA 1994;272:1932-1938.
ABSTRACT  

Patient-Directed, Nonprescription Approaches to Cardiovascular Disease
Simon
Arch Intern Med 1994;154:2283-2296.
ABSTRACT  

Sexual Dysfunction With Antihypertensive Drugs
Prisant et al.
Arch Intern Med 1994;154:730-736.
ABSTRACT  

Fortnightly Review: Impotence: diagnosis and management of male erectile dysfunction
Kirby
BMJ 1994;308:957-961.
FULL TEXT  

Evaluating Drugs after Their Approval for Clinical Use
Ray et al.
NEJM 1993;329:2029-2032.
FULL TEXT  

The Treatment of Mild Hypertension Study-Reply
Neaton et al.
JAMA 1993;270:2925-2925.
ABSTRACT  

The Treatment of Mild Hypertension Study
Safdari and Passman
JAMA 1993;270:2924-2925.
ABSTRACT  

Thirty-Month Evaluation of a Popular Very-Low-Calorie Diet Program
Flynn and Walsh
Arch Fam Med 1993;2:1042-1048.
ABSTRACT  

Single-Drug Therapy for Hypertension in Men
Johnston et al.
NEJM 1993;329:1043-1045.
FULL TEXT  

Captopril, Enalapril, and Quality of Life
Santanello et al.
NEJM 1993;329:505-507.
FULL TEXT  

Treatment of Mild Hypertension Study: Final Results
Neaton et al.
JAMA 1993;270:713-724.
ABSTRACT  

Treatment of Mild Hypertension: The More Things Change...
Black
JAMA 1993;270:757-759.
ABSTRACT  

Reduction in Long-term Antihypertensive Medication Requirements: Effects of Weight Reduction by Dietary Intervention in Overweight Persons With Mild Hypertension
Davis et al.
Arch Intern Med 1993;153:1773-1782.
ABSTRACT  

Hypertension: Steps Forward and Steps Backward
Moser and Gifford
Arch Intern Med 1993;153:1843-1846.
ABSTRACT  

Challenges in the Management of Stage 1 Hypertension
Pearce
Arch Fam Med 1993;2:717-720.
ABSTRACT  

Epidemic Obesity in the United States
Stamler
Arch Intern Med 1993;153:1040-1044.
ABSTRACT  

Weight Loss Intervention in Phase 1 of the Trials of Hypertension Prevention
Stevens et al.
Arch Intern Med 1993;153:849-858.
ABSTRACT  

Single-Drug Therapy for Hypertension in Men -- A Comparison of Six Antihypertensive Agents with Placebo
Materson et al.
NEJM 1993;328:914-921.
ABSTRACT | FULL TEXT  

Antihypertensive Therapy -- Efficacy and Quality of Life
Oparil
NEJM 1993;328:959-961.
FULL TEXT  

Reserpine and the Medical Marketplace
Lederle et al.
Arch Intern Med 1993;153:705-706.
ABSTRACT  

The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V)
Arch Intern Med 1993;153:154-183.
ABSTRACT  

National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension
Arch Intern Med 1993;153:186-208.
ABSTRACT  

Cough and ACE Inhibitors
Simon et al.
Arch Intern Med 1992;152:1698-1700.
ABSTRACT  

Do No Harm: Antihypertensive Therapy and the J Curve
Weinberger
Arch Intern Med 1992;152:473-476.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1991 American Medical Association. All Rights Reserved.