September 1, 1998
Moderate lifestyle changes can make a difference in the treatment of elderly people with high blood pressure, according to a study led by Paul K. Whelton, dean of Tulane's School of Public Health and Tropical Medicine.
Results of the three-year study conducted at four institutions on 975 participants, ages 60 to 80, was the lead article in the March 18 issue of the Journal of the American Medical Association and was featured on an edition of NBC's "Today."
TONE, short for Trial of Nonpharmacologic Interventions in the Elderly, is the first multi-center trial of sufficient size and duration to show that lifestyle modifications can be used to control high blood pressure in older people. Whelton began planting the seeds for the study 10 years ago while at Johns Hopkins Medical Center in Baltimore.
He spent 27 years at Johns Hopkins in the areas of prevention, epidemiology, community health and clinical research before coming to Tulane in 1996. The trial's participating centers--Johns Hopkins, Wake Forest, the University of Medicine and Dentistry of New Jersey and the University of Tennessee at Memphis--were selected for geographic impact and because of Whelton's familiarity with the institutions.
"Up to this point there had been no trial to document the effect of lifestyle changes on elderly patients with hypertension," Whelton says, emphasizing the impact of the disease in this country. "Two-thirds of Americans in the 60 to 80 age range have high blood pressure, a disease that contributes to heart attacks, the nation's No. 1 killer, and stroke, the nation's No. 3 killer. What we wanted to know was if sodium reduction and weight loss would make a difference."
The researchers found that even moderate changes--as little as a 25 percent reduction in sodium intake and an 8- to 10-pound weight loss--meant lower blood pressure levels for the test group. Many in the group were able to reduce or cease their medications.
"Overall we judged this trial to be very successful and powerful on many levels," Whelton says. "It says to someone in this age range that they can still get substantial benefit from moderate changes in lifestyle, that there are opportunities to reduce the need for medication, and if you are on medication there are approaches that will reduce blood pressure. What we guessed is true: this group has a capacity to achieve and maintain a behavior change."
Whelton says health is a more serious concern for the elderly because they have experienced the results of poor lifestyle habits and sickness. Behavior modifications work well for this group because they frequently have more time and resources to devote to changing their behaviors. The study helped participants implement lifestyle changes that would be permanent, such as teaching them to read nutrition labels, count sodium and calories and exercise in a manner that fits their surroundings, such as walking if they live in a safe area or taking the stairs if they live in a high-rise building.
The study was funded by the National Institutes of Health's National Institute on Aging and National Heart, Lung and Blood Institute. The NHLBI named Whelton, an authority on cardiovascular and renal disease, to its advisory council in March after publication of the groundbreaking study on hypertension.
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