Table 1.
Coding Guide for Components of Nonpharmacologic Interventions
| Intervention/Abbreviation | Brief Descriptions | Median Intensity |
|---|---|---|
| Dietary approach | ||
| DASH 34 , 35 | Participants' diet strictly follows the DASH eating pattern, which recommends a diet rich in fruits, vegetables, whole grains, and low‐fat dairy with reduced sodium and saturated and total fat content | Eating on the DASH pattern every day |
| Low‐sodium and high‐potassium salt 36 , 37 | Participants receive either a salt substitute (25%−30% potassium chloride, 50%−65% sodium chloride, and 5%–10% calcium and magnesium sulfate) to cover all cooking, or test food cooked using salt substitution | 5 g of low‐sodium and high‐potassium salt every day |
| Salt restriction 38 , 39 | The goal is to restrict daily sodium intake <100 mmol (5.85 g salt). Professional instructors give participants detailed advice about how to reduce their salt intake and to avoid foods that contain large amount of salt and also offer metric salt‐spoon or placebo to participants | Restrict sodium intake <100 mmol (5.85 g salt) every day |
| Physical exercise | ||
| Aerobic exercise 40 , 41 | Participants are supervised by project staff to perform exercise (eg, treadmill or brisk walking, jogging, bicycle training, swimming, ball games), at least 30 min/time; almost all were moderate or high intensity (60%–90% of the maximum heart rate or maximum oxygen consumption) | 3 d/wk, 50 min/time |
| Isometric training 42 , 43 | Participants perform isometric training, which involves sustained contraction against an immovable load or resistance with no or minimal change in length of the involved muscle group. Training consisted of four 2‐min isometric contractions at 30% MVC using alternate hands with a programmed handgrip dynamometer, with a 1‐min rest period between each contraction for 3 d per week | 3 d/wk, bilateral contractions at 30% of MVC |
| Resistance training 44 , 45 | Participants perform active movement progress through muscle to overcome external resistance, such as leg press, leg curl, knee extension, chest press, seated row, overhead press, triceps dip, and biceps curl, 50–60 min/d, 2–3 d/wk | 3 d/wk |
| Tai chi 46 | Tai chi js a set of Chinese systematic calisthenic exercises with slow circular movements and requires the muscles to remain relaxed while making sustained movement. Participants are taught by instructors with expertise to finish each session, which includes warm‐up exercises, tai chi practice, and cool‐down exercise | 3 d/wk, 50 min with 50% to 60% Vo 2max |
| Qigong 47 | Qigong, a traditional Chinese health and fitness exercise, includes qi gong ba duan jin, shu xin ping xue gong and dao yin shu qigong. Qigong experts help participants to reconstruct this instrument using a warming‐up exercise, qigong, and cool‐down exercise | Qigong classes 2 d/wk, home practice 2 d/wk |
| Interventions to reduce stress | ||
| Breathing control 48 , 49 | Use of a device guides participants toward slow and regular breathing in the evening (the goal is <10 breaths/min with accumulating ≥40 min of therapeutic breathing per week) | Every day, 15 min/time |
| Meditation 50 | Transcendental meditation is considered the principal approach for stress reduction. Participants are instructed by a professional meditation instructor and then practice 20 min twice a day while sitting comfortably with eyes closed | Practice meditation 20 min twice a day |
| MBSR 51 , 52 | MBSR is a multicomponent group intervention that provides systematic training in mindfulness meditation as a self‐regulation approach to stress reduction and emotion management. It can be explored through activities including but not limited to gentle stretching and mindful yoga, a meditative body scan, mindful breathing, and mindful walking | Practice MBSR techniques 45 min every day |
| PMR 53 , 54 | PMR involves directing the participants' attention to tense and relax various muscle groups throughout the body systematically to achieve deep relaxation | Practice PMR techniques 15–20 min twice a day |
| Yoga 55 | Participants are instructed by a professional yoga instructor through yoga home training or a yoga class and practice yoga at least 30 min/d, 3 d/wk | Practice yoga 3 d/wk, 45 min |
| Interventions to lose weight | ||
| Low‐calorie diet 56 , * | Participants who are overweight or obese using the low‐calorie diet induce weight loss are provided with detailed guidelines on the daily number of servings from each food group and on fat intake to achieve weight loss of ≤10% of each participant's baseline body weight. To enhance compliance with the low‐calorie diet, participants are provided with food diaries that assisted them in recording intake | Low‐caloric diet every day for weight loss |
| Exercise 56 , * | Participants who are overweight or obese in the exercise training group are provided with an individualized exercise prescription consisting of 30–40 min exercise (eg, aerobic exercise or others), at least 3 d/wk, keeping 60%–80% of the maximum heart rate. To enhance compliance, details of each exercise session are recorded in a training diary and reviewed by the study's counselor | Exercise 3 d/wk, reach 60%–80% peak heart rate |
| Low‐calorie diet plus exercise 56 , * | Participants who are overweight or obese using the exercise training plus low‐calorie diet for weight loss are provided with detailed guidelines on a low‐calorie diet to achieve weight loss and decrease BMI. In addition, they perform systematic exercise training, 30–45 min/d, at least 3 d/wk, keeping 60%–80% of the maximum heart rate | Low‐caloric diet for losing weight, with exercise 3 d/wk, reaching 60%–80% peak heart rate |
| Restrict alcohol | ||
| Alcohol restriction 57 , 58 , † | Participants reduce their alcohol consumption to <14 drinks weekly or 50% cut or total abstinence, with education for alcohol restriction provided by investigators | Reduce alcohol intake by half or abstain |
| Combined intervention | ||
| Aerobic exercise+DASH 59 | Participants follow the DASH eating pattern and perform aerobic exercise | At least 5 d/wk, 30–60 min aerobic exercise plus DASH |
| Aerobic exercise+resistance training 60 | Participants attend an aerobic exercise session and a resistance training session at the center at least twice a week | At least 2 d/wk, endurance training and resistance training |
| Salt restriction+DASH 35 | Participants follow the DASH eating pattern with salt restriction (sodium intake <100 mmol/d) | Follow diet every day |
| Salt restriction+low‐calorie diet plus exercise 61 , * | Participants who are overweight or obese follow a low‐sodium (80 mmol/d) diet with low‐calorie intake to achieve weight loss of 4.5 kg | Low‐sodium and low‐calorie diet every day; 3 d/wk, reach 60%–80% peak heart rate |
| Comprehensive lifestyle modification | ||
| Comprehensive lifestyle modification 62 , 63 | Participants are recommended to comprehensively modify their lifestyle, such as lose weight, restrict sodium intake, reduce alcohol consumption, increase physical exercise to a moderate degree, give up cigarette smoking, and learn to manage stress | Use lifestyle modification every day |
| Control group | ||
| Usual care | Participants keep usual lifestyle and do not change during the period of intervention | |
Brief descriptions of 22 interventions plus usual care (as control) are summarized, with 17 nonpharmacologic interventions targeted to the general population with hypertension or prehypertension. BMI indicates body mass index; DASH, Dietary Approaches to Stop Hypertension; MBSR, mindfulness‐based stress reduction; MVC, maximum voluntary contraction; and PMR, progressive muscle relaxation.
*
Nonpharmacologic intervention targeted only people who were overweight and obese who had hypertension or prehypertension.
†
Nonpharmacologic intervention targeted only people who used alcohol habitually who had hypertension or prehypertension.