what is the effect of pharmacological treatment and lifestyle modification (I) on blood pressure control and quality of life (O)compared to pharmacological treatment only (C)?

Below are the samples of the 2 tables that you have to make for the first written requirement (analysis, appraisal and synthesis of the 2 evidence). This is only one
study I am showing you, you have to do two of them and APA style. This study is very big that the group had to put all these information. PREMIER trial is a big study.
I will help you with any questions that you may have and help you sort out your topic and question but ask right away and don’t waste time. You have to understand and
analyze the whole study one by one, not just putting what’s in the abstract on the tables.
PICO Question: In African-Americans between ages of 50 to 80 years old (P), what is the effect of pharmacological treatment and lifestyle modification (I) on blood
pressure control and quality of life (O)compared to pharmacological treatment only (C)?

Note: lifestyle modification for this group meant: DASH diet, implementation of mild to moderate exercise plan, excess body weight control, limitation of alcohol
consumption, and stress reduction. (This group got the highest grade in almost everything as they were very thorough and had very good teamwork and cohesiveness)

Table 1: Included Studies
Author, Year, Title, and Source Design and General Quality Sample Size and Participants Interventions Outcomes
Funk, K.L., Elmer, P.J., Stevens, V.J., Harsha, D.W., Craddick, S.R., Lin, P.H., Young, D.R., Champagne, C.M., Brantley, P.J., McCarron, P.B., Simons-Morton, D.G., &
Appel, L.J. (2008). PREMIER- A trial of lifestyle interventions for blood pressure control: Intervention design and rationale, Health Promotion Practice, (9)3, 271.-
280.
PREMIER was a multicenter, randomized, controlled trial to determine the BP-lowering effects of two 18-month-long multi-component lifestyle interventions.
The Established Guidelines (EG) and Established Guidelines + DASH (EG + DASH) interventions were compared to an advice-only comparison condition. Both interventions
included the most current established guidelines from JNC at the time of the intervention development, JNC V (weight loss, limited sodium and alcohol intake, and
increased physical activity; National Institutes of Health [NIH], 1992). After the start of the PREMIER trial, the DASH diet was added to the JNC VII guidelines (U.S.
Department of Health and Human Services, National Institutes of Health, & National Heart, Lung, and Blood Institute, 2004). PREMIER participants were generally
healthy men and women age 25 years and older with high-normal BP (SBP = 130-139, DBP = 85-89) or stage 1 hypertension (SBP = 140-159, DBP = 90-99) but not taking BP
medication, and who met JNC V (NIH, 1992) criteria for a 6-month trial of non-pharmocologic therapy.
Participants were recruited through mass mailings, advertisements, and news stories.
Baseline characteristics were similar for each randomized group. Overall, 34% of participants were African American and 62% were women; the mean age was 50 years.

The goal was to design and develop lifestyle interventions that could be readily transferred into general health care settings. The interventions were designed
to encourage lifestyle changes by focusing on motivation and support and to be culturally relevant for African American and other minority participants.
An intervention format and delivery approach that integrated diet and physical activity components and balanced information with behavioral strategies was developed.
The interventions were based on key theoretical constructs developed to guide health behavior change and on practical lessons learned from previous trials of weight
loss, dietary change, and cardiovascular disease (CVD) risk reduction (Elmer, Fosdick, et al., 1995; Elmer, Grimm, et al., 1995; Stevens et al., 1993; Stevens et al.,
2001; Trials of Hypertension Prevention Collaborative Research Group, 1997; Whelton et al., 1998). The interventions were derived from social cognitive theory
(Bandura, 1986) and behavioral self-management (Watson & Tharp, 2002) and were constructed using the stages-of-change model (Prochaska & DiClemente, 1983) and
motivational enhancement approaches (Miller & Rollnick, 2002). These approaches emphasize the individual’s ability to achieve success by setting goals, developing
behavior change plans, monitoring progress toward the goals, and attaining skills necessary to reach the goals. Successful approaches enhance self-efficacy and outcome
expectancies, which are critical mediators of behavior change (Bandura, 1997).
Established national guidelines for blood pressure control (weight loss, reduced sodium and alcohol intake, and increased physical activity), and one intervention also
included the dietary approaches to Stop Hypertension (DASH) diet.
The interventions emphasized moderate-intensity activity (50% to 69% maximal heart rate), as many adults prefer moderate over vigorous activity (Curry, McBride,
Grothaus, Louie, & Wagner, 1995), and moderate exercise is associated with lower injury rates than vigorous exercise. Consistent with national recommendations,
vigorous activity was permitted for participants who had no medical contraindications (American College of Sports
Medicine, 2000).
Outcomes were measured at baseline and 6 and 18 months and included SBP, DBP, serum lipids, and prevalence of hypertension. The main results at 6 months of the
PREMIER clinical trial have been reported elsewhere (Appel et al., 2003). Briefly, the trial concluded that individuals can make multiple lifestyle changes to
effectively lower BP and control hypertension. In addition, participants in the EG and EG + DASH interventions lost weight, reduced sodium intake, and increased
physical fitness. Those in the EG + DASH group increased intake of fruits, vegetables, and dairy products.
Using motivational enhancement techniques, the interventionists helped participants make action plans for the following weeks. Participants practiced each change and
gained confidence before moving on to the next change. The concept of making small incremental changes over time is consistent with behavior change theory and
addressed the overwhelming nature of implementing many simultaneous lifestyle changes.
The 18-month results of the PREMIER study, reported elsewhere (Elmer et al., 2006) demonstrate that individuals with prehypertension and stage 1 hypertension can make
and sustain, during a period of 18 months, multiple lifestyle modifications that have the potential to control BP and reduce the risk of chronic disease.
In addition, participants maintained a 4% weight reduction during the18 months of intervention.
Table 2. Rating of Evidence and Summary of Findings
Author, Year, Title, and Source Level of
Evidence Findings (BRIEF)
Funk, K.L., Elmer, P.J., Stevens, V.J., Harsha, D.W., Craddick, S.R., Lin, P.H., Young, D.R., Champagne, C.M., Brantley, P.J., McCarron, P.B., Simons-Morton, D.G., and
Appel, L.J. (2008). PREMIER- A trial of lifestyle interventions for blood pressure control: Intervention design and rationale, Health Promotion Practice, (9)3, 271.-
280.

II Evaluation of multi-component interventions such as evaluated in PREMIER can help refine our understanding of the complexities involved in making
multiple lifestyle changes simultaneously and the impact such changes have on BP, especially in minority populations at higher risk for hypertension. The approaches
described in this study provided a useful framework and practical model for implementing lifestyle change interventions in health care settings and link known diet and
physical activity research recommendations to everyday practice.
The 18-month results of the PREMIER study, reported elsewhere (Elmer et al., 2006) demonstrate that individuals with pre-hypertension and stage 1 hypertension can make
and sustain, during a period of 18 months, multiple lifestyle modifications that have the potential to control BP and reduce the risk of chronic disease. In addition,
participants maintained a 4% weight reduction during the 18 months of intervention. Such results lend support to health care organizations to choose this model for
implementing multi-component lifestyle change interventions to reduce BP in diverse populations.

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