TABLE 2.
Effect of community-based interventions on study outcomes, Community-based interventions for cardiovascular disease prevention in low- and middle-income countries: a systematic review, 2000–2019.
| Author | Knowledge | Physical activity | Diet | Smoking | Alcohol | Body weight | Blood pressure | Blood glucose | Lipid profile |
|---|---|---|---|---|---|---|---|---|---|
| Baghaei, 2010 [25] | Regular daily exercise significantly increased by about 45% among the high risk population in the interventional area (from 15 to 28%) | Improved fruit and vegetable consumption, more use of unsaturated fats and reduced salt intake among the high risk population in the intervention group compared to reference group (p < 0.05) | Smoking significantly decreased among the high risk persons in the intervention group compared to reference group (p < 0.03) | ||||||
| Kelishadi, 2011 [26] | Leisure time physical activity increased in women and declined in men of both communities with changes greater in the intervention area No significant change in transport physical activity in intervention area but sharply decreased in reference area Regular morning curricular exercise significantly was greater in the intervention community compared to control (p < 0.001) | Consumption of hydrogenated fat decreased significantly in the intervention community, but it remained nearly constant in the reference area (p < 0.05) Consumption of liquid oil (up to 2 times a day) increased in the intervention community, whereas it decreased in the reference area Consumption of salty/fat snacks slightly decreased in intervention area but increased in the reference area Fast food consumption did not significantly change in intervention area but increased sharply in reference area | Prevalence of current smoking decreased in men living in intervention area but increased slightly among those in reference area. However, no significant change was observed among women in both groups Attempt to smoking decreased among youths in intervention areas but remained constant in the reference area | ||||||
| Rabiei, 2010 [27] | From 2000 to 2002, the daily physical activity (PA) among both genders decreased in both intervention and reference communities Leisure-time PA increased significantly in the intervention area, but decreased in the reference area The transportation PA did not significantly change in the intervention area, but showed a remarkable decline in the reference area among both genders. No significant change in worksite PA. | ||||||||
| Sarrafzadegan, 2009 [28] | Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (–68 metabolic equivalent task (MET) minutes per week vs. –114 MET minutes per week, respectively; p < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas | Changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points vs. –1.2 points, respectively; p < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% vs. –2.0%, respectively; p < 0.001) | Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (p < 0.05) but not among women | ||||||
| Sarrafzadegan, 2009 [29] | Intervention activities positively affected the total and leisure-time physical activities in men, but not women Total daily physical activity decreased in both groups over the years but trend was slower in intervention group (p < 0.001) | Intervention resulted into gradual improvement in the nutritional status compared to control with trends similar in men and women (p < 0.001) Dietary choice of both sexes showed modest degrees of improvement | Smoking status of men improved during the study period (except 2004), while the effect on women was not significant | ||||||
| Azizi, 2013 [30] | After intervention, chance for being less active was significantly higher in control men as compared to intervention men after 3.6 years: OR = 1.2 (1.01–1.44, p < 0.05) | No significant difference in energy intake and macronutrient consumption between two groups at baseline and after intervention | Prevalence of abdominal obesity increased significantly in both intervention and control groups. Comparison between groups revealed significant reduction in abdominal obesity in intervention group compared to control (OR 1.24, 1.07–1.44, p < 0.014) | Elevated blood pressure reduced in both intervention and control groups but difference between groups was not statistically significant | Prevalence of elevated fasting glucose increased only in the control group. On group comparisons, intervention group had significantly reduced elevated fasting glucose (OR 1.67, CI 1.43–1.95, p < 0.001) | Prevalence of low HDL cholesterol increased significantly in both groups while that of elevated triglycerides decreased significantly compared to baseline values. Compared to control, intervention significantly reduced elevated triglycerides (OR 1.18, CI 1.04–1.34, p < 0.014) and low HDL cholesterol (OR 1.52, CI 1.32–1.76, p < 0.001) | |||
| Mirmiran, 2008 [31] | Mean dietary carbohydrate, mean dietary protein and fat intakes decreased in both group but significant in intervention group. After adjustments, only total dietary cholesterol had a significant decrease (p < 0.05. While the dietary vitamin a values decreased in controls, it increased in the intervention. Vitamin B6, B12, and C and zinc intakes increased significantly in both groups, while the iron intakes significantly decreased in both groups. No significant difference in energy and nutrient intakes between intervention and controls | Body mass index increased significantly in both groups but difference not statistically significant (p = 0.53) | Diastollic blood pressure decreased significantly in both groups but higher in the intervention group (p = 0.08). Systollic blood pressure increased significantly in the control group with no significant difference with intervention group (p = 0.13) | Significant decrease in fasting blood sugar in intervention group and significant increase in control group and difference between intervention and control group was statistically significant (p < 0.01) | Total cholesterol and HDL and LDL decreased significantly in both groups. There was significant decrease in total cholesterol in the intervention group compared to controls (p = 0.01) | ||||
| Vijver, 2016 [32] | Significant decrease in the numbers of those reporting inadequate physical activity among intervention compared control group at population level (OR 0.20, p < 0.001) | Insufficient intake of fruits and vegetables increased significantly at population level both in intervention (OR 1.30, 95% CI 1.08 to 1.56, p = 0.006) and control (OR 1.42, 95% CI 1.15 to 1.76, p = 0.001) settings but difference between groups was not significant (OR 0.88, 0.67 to 1.16, p = 0.375) | In the control group, there was significant decrease at population level in smoking (OR 0.73, 95% CI 0.56–0.95). The difference in intervention group was not significant (OR 1.19, 95% CI 0.92 to 1.53, p = 0.181). Among patients with hypertension in the control group, smoking (OR 0.51, 95% CI 0.28 to 0.90, p = 0.021) reduced significantly | Significant reduction in alcohol use at population level in the control group (OR 0.71, 95% CI 0.57–0.88). Among patients with hypertension in the control group, alcohol use (OR 0.62, 95% CI 0.38 to 0.99, p = 0.044) reduced significantly | No significant reduction in mean SBP and DBP at population level. No significant difference in SBP reduction among patients with hypertension. However, DBP decreased more in the control group than the intervention one (p = 0.028). Significant reduction in SBP and DBP in both intervention 2.75 mmHg (p = 0.001) and control groups 1.67 mmHg (p = 0.029) and larger reductions among those with hypertension in (intervention (SBP 4.82 mmHg, p < 0.001; DBP 7.55 mmHg, p < 0.001) and control (SDP 14.05 mmHg, p < 0.001; DBP 10.67 mmHg, p < 0.001) | ||||
| Daivadanam, 2018 [33] | Significant, modest increase in fruit intake from baseline in the intervention arm (12.5%) and control (6.6%) but no difference between the groups. Significant increase in vegetable intake in intervention (13.99%) and control arms (13.66%) but no difference between the groups. Significant increase in vegetable procurement by 19% in the intervention arm compared to the control arm (p = 0.008). Monthly household consumption of salt, sugar and oil was greatly reduced in the intervention arm (p < 0.001) | ||||||||
| Thankappan, 2018 [34] | No statistically significant difference in leisure time physical activity between intervention and control groups (RR = 1.20, p = 0.36) | Intervention participants more likely to consume 5 or more servings of fruits and vegetables (RR 1.83, p = 0.008) compared with control | No statistically significant difference in tobacco use between intervention and control groups (RR = 0.79, p = 0.11) | Intervention participants had a greater reduction alcohol use (RR 0.77, p = 0.018) and the amount of alcohol consumed was lower among intervention participants (p = 0.030) | No statistically difference in waist circumference (mean difference: 0.67, p = 0.14) and waist to hip ratio (mean difference: 0.008, p = 0.12) between intervention and control groups | No statistically difference in systollic (mean difference: 1.22, p = 0.13) and diastollic blood pressure (mean difference: 1.12, p = 0.06) between intervention and control groups | Diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66 ± 1.16, p = 0.36). Compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: −1.50 points, p = 0.022) | No statistically significant difference observed among intervention and control groups for total cholesterol (mean difference: 0.01, p = 0.79), LDL cholesterol (mean difference: 0.02, p = 0.73) and triglycerides (mean difference: 0.96, p = 0.07) | |
| Jayakrishnan, 2013 [35] | Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months | ||||||||
| Ramachandran, 2006 [36] | Physical activity showed an improvement from 41.7% to 58.8% in LSM and from 45.9% to 62.9% in LSM + MET group | Improvement in diet adherence registered in LSM group from 62.5% to 81.6% and LSM + MET groups from 62% to 81.9% | Significant increase in mean body weight in the control group at annual follow-up. Among intervention, increase was only in the lifestyle group at 24 months (p = 0.035) Mean waist circumference did not significant differ in any group relative to baseline values | Significant relative risk reduction of 28.5%, p = 0.018 in the LSM group, 26.4% with MET group (p = 0.029) and 28.2% in LSM + MET group (p = 0.022) compared to control group | |||||
| Ramachandran, 2013 [37] | Adherence to physical activity did not differ between the intervention and control groups | Intervention group had significantly greater diet adherence compared to control group (p = 0.0442) | No significant effect of intervention on BMI and waist circumference | No significant effect of intervention on systollic and diastollic blood pressure | 50 (18%) of men in intervention group developed type 2 diabetes compared with 73 (27%) in the control group (absolute risk reduction of 9%). Intervention thus reduced incidence of type 2 diabetes. (p = 0·015) | No significant effect of intervention on serum cholesterol and triglycerides. However, the effect on HDL cholesterol was significant | |||
| Nishtar, 2007 [38] | Significant positive changes in knowledge levels in intervention district compared with baseline levels in relation to a heart healthy diet (p < 0.001), beneficial level of physical activity (p < 0.001), causes of high blood pressure (p < 0.001) and heart attack (p < 0.001) and its causes (p < 0.001) and the effects of high blood pressure (p = 0.003) and active and passive smoking on health (p < 0.001). In control group, significant changes were for knowledge on: effects of smoking on health (p = 0.013). Significant differences were observed for all knowledge variables in favor of the ntervention | No changes were seen in the level of physical activity | Significant differences noted in consumption of two or more servings of vegetables per day within the intervention group (p < 0.001) and between the intervention and control group at the end of the intervention (0.020). No significant differences observed regarding consumption of five or more servings of fruits and vegetables, consumption of two or more fruit servings and type of oil/fat/ghee used for cooking | No significant changes observed comparing pre and post smoking pattern in both intervention and control groups. In comparing intervention and control sites post scores, there was a difference in usage of smokeless tobacco (p = 0.022) | |||||
| Jafar, 2009 [39] | Median metabolic equivalent scores for physical activity increased in the HHE and GP group remained unchanged in the GP only and HHE only groups, and decreased in the no intervention group (p = 0.030 for difference among groups) | Proportion of current smokers decreased from baseline to the last follow-up visit in all 4 groups (p < 0.001 in each). A 12.3% decrease in the HHE and GP group, an 11.9% decrease in the HHE-only and GP-only groups, and a 9.5% decrease in the no intervention group (p < 0.001 for difference among groups) | Non-significant increase in mean BMI in all 4 groups but most marked in the no intervention group (0.20 [CI, −0.13 to 0.53] vs. 0.04 [CI, −0.38 to 0.05] in the HHE and GP group, 0.04 [CI, −0.19 to 0.28] in the GP-only group, and 0.09 [CI, −0.16 to 0.34] in the HHE-only group; p = 0.89 for difference among groups) | Decrease in SBP was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9–12.8 mm hg]) than in the GP-only (5.6 mm Hg (3.7–7.4), HHE-only (5.6 mm Hg (3.7–7.5) or no intervention groups (5.8 mm Hg [CI, 3.9–7.7 mm hg] in each; p < 0.001). DBP decreased in all groups but no significant difference in comparing groups (p = 0.27). Substantially greater proportion of patients achieved controlled blood pressure in the HHE and GP group than in other groups, p = 0.003) | |||||
| Fottrell, 2019 [40] | Increases in ability to report one or more valid causes, symptoms, complications, and strategies for prevention and control of diabetes were observed in both intervention groups compared with control, with the effect consistently greatest in the PLA group (p < 0.01) | No significant difference in participants achieving an average of more than 150 min of physical activity per week among the intervention groups (PLA 0.83 (0.53–1.30; p = 0.418 and mHealth 0.98 (0.62–1.57; p = 0.945) when compared to control | No statistical difference in mean number of portions of fruits and vegetables consumed per day in both PLA (0.29 (0.10–0.69; p = 0.143) and m health (−0.19 (−0.53 to 0.15; p = 0.274) groups compared to control | No significant difference between the PLA and mHealth group compared control | Large reduction in combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group, absolute reduction of 20·7% (95% CI 14·6–26·7) 2 years cumulative incidence of diabetes among intermediate hyperglycaemia cohort was significantly lower in the PLA group compared with control, absolute incidence reduction of 8·7% (3·5–14·0). No evidence of effect of mHealth on combined prevalence of intermediate hyperglycaemia and diabetes or the incidence of diabetes (1·02, 0·73–1·43) | ||||
| Nguyen, 2012 [41] | In control group, physical inactivity only significantly changed in men and in intervention group, significant increase was in both men and women. When both groups were compared, significant decrease was observed in females | Prevalence of salty diets decreased significantly in intervention group and was unchanged in control group (p < 0.001) | Prevalence of smoking did not significantly change | Reduction in alcohol consumption in both intervention and control communities (p < 0.01) | Waist circumference and waist hip ratio significantly increased in both groups (p < 0.01). Weight and BMI was unchanged in intervention group but significantly reduced in control community for BMI in both sexes (p < 0.05) and weight in women (p < 0.01). Intervention group registered significant increase in weight, BMI and waist circumference in women and in men, BMI also increased | SBP reduced in both groups while DBP reduced only in the intervention group (p < 0.01). Comparing changes over time between groups, SBP and DBP significantly decreased in intervention group. SBP vs DBP (3.3 and 4.7 mmHg in women vs. 3.0 and 4.6 mmHg in men, respectively) | |||
| Chandraratne, 2019 [42] | No significant difference in odds of engaging in recommended levels of leisure time physical activity between groups at follow-up (p = 0.15) and mean sedentary minutes (p = 0.94) | Significantly higher odds of consuming one or more serving/day of fruits (OR 1.71, 1.10–2.65, p = 0.02) and significantly lower odds of consuming two or more snacks per day (OR 0.32, 0.21–0.48, p < 0.001) in intervention than control group. No significant difference in the consumption of vegetables or sugar sweetened beverages between groups | No significant difference in proportion of smokers in both groups | No significant difference in proportion that consumed more than two drinks per day for men and one drink for women | Significantly lower mean body weight (61.8 kg [12.7]) and BMI (24.4 kg/m2) in intervention than control group (body weight 64.0 kg [12.8], BMI 25.5 kg/m2 (4.7)). Mean difference: Body weight −2.83 kg (−3.31 to −2.35) and BMI (−1.12 kg/m2 (−1.32 to −0.94)). More pronounced difference among overweight persons (body weight −3.69 kg and BMI −1.50 kg/m2, p < 0.001) | No significant change in blood pressure from baseline to endline in both groups including among hypertensives. Mean difference in SBP (−0.88) and DBP (−0.94) between intervention and control groups was also not significant | |||
| Joshi, 2019 [43] | Proportion of individuals who use smokeless tobacco significantly declined between baseline and 12 months in both intervention and control groups and difference between groups was significant (p = 0.001). Proportion of individuals who smoked declined by 4.1% in intervention arm and by 2.6% in control arm but the difference between the two groups was not statistically significant | Significant decline in SBP (mmHg) from baseline in both groups-controls 130.3 ± 21 to 128.3 ± 15; intervention 130.3 ± 21 to 127.6 ± 15 (p < 0.01 for before and after comparison) but there was no difference between the two groups at 12 months (p = 0.18) | |||||||
| Gunawardena, 2016 [44] | The intervention group had a significantly higher odds of engaging in adequate physical activity than the control group (AOR 3.25 (95% CI 1.87–5.62). Leisure-time activity showed a significant difference between the groups (p < 0.0001). A significantly greater increase in the number of daily steps in intervention than the control group (p < 0.0001) | No significant difference in individual-level food consumption between the two groups including fruits and vegetables consumption after the intervention, but the intervention group showed a significant decrease in household-level purchase of biscuits and ice cream than the control group (p < 0.0001 and p = 0.03, respectively) | Intervention group had a significantly lower mean of weight and BMI than did control group (p < 0.0001); mean (95% CI) effect between groups was −2.49 (−3.38 to −1.60) kg and −0.99 (−1.40 to −0.58) kg/m2 | ||||||
| Joshi, 2012 [45] | No statistically significant effect on knowledge about 6 lifestyle factors affecting CVD risk (p = 0.15) | No significant difference in mean number of days of light and medium/heavy physical activity (p = 0.78) | Individuals in the villages who received a health promotion intervention were significantly more likely to avoid consumption of oily foods (p = 0.01). No change in mean no. of days eat fruit, green leafy vegetables and salt consumption | No significant change in proportion not currently using tobacco (p = 0.74) | No change in mean body mass index, mean waist circumference | No significant change in mean systolic, diastolic between intervention and control groups following intervention | |||
| Lu, 2015 [46] | Improvements in hypertension-related knowledge score registered in all groups but greatest in group 3, then 2 and 1 | Regular physical activity increased in all groups progressively from group 1 (self-learning reading) to 2 (regular didactic lecture) and highest in 3 (interactive education workshops) | Adherence to appropriate salt intake was progressively greater from group 1 to 3 | No significant difference in proportion of current smokers in all groups | No significant difference in proportion of alcohol drinkers in all groups | BMI decreased significantly in group 1 (self-reading) and 3 (interactive education workshop) - largest reduction and waist and hip ratio decreased significantly only in group 3. The difference across groups was statistically significant | Proportion of subjects with normalized BP increased in group 2 (41.2%–63.2%, p < 0.001) and more substantially in group 3 (40.2%–86.3%, p < 0.001). No significant change in group 1 | No significant differences in serum total cholesterol and LDL concentration among groups. Serum total cholesterol decreased significantly in group 2 and 3 and not 1. Serum triglycerides concentration decreased in group 1 only. HDL concentrations increased significantly in group 1 and 3 but not 2. Fasting LDL concentrations increased significantly in group 1, didn't change significantly in group 2 and decreased significantly in group 3 | |
| Lv, 2014 [47] | Tobacco related knowledge significantly improved in intervention compared to control. Diet and physical activity knowledge and beliefs decreased in intervention compared to control | The metabolic equivalent of physical activity significantly increased in intervention (p = 0.023) compared to control (p = 0.201) | The fruit and vegetable consumption score significantly increased in both the intervention (24.84 vs 25.97, p = 0.036) and comparison (24.25 vs 26.67, p < 0.001) areas but difference between the two not significant | A statistically significant decline in the prevalence of smoking observed in intervention (25.2% vs 18.7%, p < 0.001) compared with the comparison area (18.0% vs 16.4%, p = 0.343). Statistically significant difference in prevalence also observed among men | |||||
| Chao, 2012 [48] | Intervention group demonstrated significant improvement in physical activity duration per week | Intervention group demonstrated significant improvement in diet score compared to control group | Waist to hip ratio significantly reduced in the intervention group compared to controls | Systollic blood pressure significantly reduced in the intervention compared to controls. No difference observed in diastollic blood pressure between groups | Fasting blood sugar significantly reduced in the intervention group compared to controls | No difference observed in lipidemia patients triglyceride between groups | |||
| Huang, 2011 [49] | Statistically significant changes in hypertension knowledge (p < 0.05) | The percentage of participants physically active increased from 43.3 to 59.7% in the intervention group and 43.7–70.2% in the control group, both statistically significant | Participants in intervention group exhibited a significantly greater improvement in dietary habits including reducing salty food intake (13.6% vs. 21.7%), fat intake (22.9% vs. 31.9%) comparison with those in the control group. Consumption of pickled food reduced in intervention and increased in control group though not statistically significant. Reduction in consumption of pickled food registered in both groups but difference not significant (p = 0.641) | Smoking reduced in the intervention group (29.5–26.0%) and increased in the control group (23.9–27.0%) and the difference was not statistically significant | Intervention group participants exhibited a significantly greater improvement in alcohol consumption compared with control group (9.6%) vs. 18.0%, p < 0.05) | A significant reduction in the prevalence rate of hypertension in only the intervention group, which was from 35.4 to 22.5%. No change in the prevalence of hypertension in the control group. Significant increase in treatment (p < 0.05) and control rates of hypertensive patients in both groups (p < 0.05) and between group in favor of the control group (p < 0.05) | |||
| Zhang, 2018 [50] | Comparing intervention and control groups, adherence to physical activity was significant at both 12 and 24 months | Comparing intervention and control groups, adherence to high diet score was significant at both 12 and 24 months | Adherence to non-smoking among intervention compared to control was not significant at both 12 and 24 months | Adherence to moderate alcohol use among intervention compared to control was not significant at both 12 and 24 months | Average waist circumference lower in intervention group but not statistically significant both at 12 and 24 months | Average systollic and diastollic BP significantly lower in intervention group compared to control both at 12 and 24 months | Fasting plasma glucose significantly lower in intervention group compared to control both at 12 and 24 months | Total cholesterol significantly lower in intervention group than control both at 12 and 24 months | |
| Ibrahim, 2016 [51] | Greater proportion of participants from the Co-HELP group met the clinical recommended target physical activity of >600 METS/min/wk (60.7% vs 32.2%, p < 0.001) compared to the usual care group | Intervention group showed a greater percentage of participants (13.9%) who met the dietary aims (to reduce 20 ± 25 kcal/kg energy intake) as compared to usual care group (9.6%) but not statistically significant | Greater proportion of intervention participants met the clinical recommended target of 5% or more weight loss from the initial weight (24.6% vs. 3.4%, p < 0.001). Change in waist circumference was −2.44 cm (−4.75 to −0.12, p < 0.05) | At 12 months, SBP reduced in intervention compared to control group but not significant (−1.71 (−3.97 to 0.56)). DBP changed by −2.63 mmHg (−3.79 to −1.48, p < 0.01) compared to the control group | Analysis of between-groups at 12 months (mean difference, 95% CI) revealed that the Co-HELP participants' mean fasting plasma glucose reduced by −0.40 mmol/L (−0.51 to −0.28, p < 0.001), 2 h post glucose by −0.58 mmol/L (−0.91 to −0.24, p < 0.001), HbA1C by −0.24% (−0.34 to −0.15, p < 0.001) | HDL cholesterol increased by 0.12 mmol/L (0.05–0.19, p < 0.01), compared to the usual care group | |||
| Mcalister, 2000 [52] | Cessation rates were 7–26% in pitkäranta and 1–2% in the comparison area (p < 0.05) | ||||||||
| Aung, 2019 [53] | Intervention participants (25.62%) achieved a significantly higher smoking cessation rate than the control participants (11.32%), adjusted analysis (AOR 2.95, p < 0.001) | ||||||||
| Latina, 2020 [54] | No significant difference between the two groups in exercise | No significant change in tobacco use between groups | At one-year of follow-up, the overall FBS was significantly different between the peer group intervention and control groups [9.1 (SD 2.7) vs. 8.5 (SD 2.6), p = 0.028 | ||||||
| Anthony, 2015 [55] | No significant difference between intervention and control in change in physical activity | The proportion eating five portions of fruit and vegetables increased in intervention compared to control group (6.9% vs. 1.5%, p < 0.001). Salt intake increased in both groups more in the control compared to the intervention group (p = 0.014) | Prevalence of tobacco use significantly reduced in men (6.0% vs. 2.6%, p < 0.001) in intervention compared with control. In women, tobacco use slightly increased in both groups with no difference | No significant difference between intervention and control in change in overweight | |||||
| Neupane, 2018 [56] | No significant differences between intervention and control groups at follow-up in proportions of people who had low physical activity (OR = 0·77, 95% CI 0 24–2·45) | No significant differences between the intervention and control groups at follow-up in proportions of people who consumed 5 g or more of salt each day (0·80, 0·56–1·14) and ate less than five servings of fruit and vegetables each day (OR = 1·09, 95% CI 0 38–3·13) | No significant differences between the intervention and control groups at follow-up in proportions of people who smoked daily (OR 0·79, 95% CI 0 46–1·37) | No significant differences between groups at follow-up in proportions of people who consumed harmful amounts of alcohol (OR 1·07, 95% CI 0 61–1·90) | Mean SBP at 1 year was significantly lower in the intervention group than in the control group for all cohorts: (Difference –2·28 mm Hg (95% CI –3·77 to –0·79, p = 0·003) for normotensive participants, –3·08 mm Hg (–5·58 to –0·59, p = 0·015) for prehypertensive, and –4·90 mm Hg (–7·78 to –2·00, p = 0·001) for hypertensive participants |