Objective: To assess effects of a cognitively based program on health-related behaviors and cardiovascular risk factors in overweight drug-treated hypertensives.Study Design and Setting: In a clinical trials center, volunteers, recruited by advertisement, were randomized to usual care (N = 118) or to a 4-month program (N = 123) incorporating weight loss; a low-sodium diet, high in fruit, vegetables, and fish; and increased physical activity. Diet, physical activity, weight, blood lipids, glucose, and insulin were measured at 4 and 16 months.Results: Ninety-eight usual care and 106 program participants completed the 4-month assessment; 90 and 102, respectively, completed follow-up. Using intention-to-treat analysis, relative to usual care, net changes with the program at 4 months were as follows: dietary fat (-2.6% energy; P < 0.001); sodium (-290 mg/d; P = 0.004); energy (-313 mJ/d; P = 0.005); fish (+2.1 serves/wk; P < 0.001); vegetables (+3.0 serves/wk; P < 0.001); physical activity (+37 min/wk; P = 0.004); weight (-2.8 kg; P < 0.001); waist girth (-3.1 cm; P < 0.001); total cholesterol (-0.2 mmol/L; P = 0.017); and triacylglycerol s (-0.12 mmol/L; P = 0.002). One year later, net changes included dietary fat (-2.2% energy; P < 0.001); sodium (- 150 mg/d; P = 0.029); fish (+2.0 serves/wk; P < 0.001); vegetables (+4.3 serves/wk; P < 0.001); weight (-2.5 kg; P = 0.001); waist girth (-3.1 cm; P < 0.001); high-density lipoprotein cholesterol (+0.03 mmol/L; P = 0.031).Conclusion: Improvements in behaviors and risk factors, several maintained long term, suggest the potential for long-term benefits in hypertensives. (c) 2007 Elsevier Inc. All rights reserved.