- Researchers recently investigated whether lifestyle changes could lower blood pressure in people with resistant hypertension.
- Resistant hypertension refers to high blood pressure that does not respond well to medical treatment.
- Their results suggest that supervised lifestyle changes, including dietary changes, group counseling, and a cardiac rehabilitation exercise program, yield similar results to blood pressure lowering drugs.
- The researchers hope their findings will encourage policymakers to consider cardiac rehabilitation as a new treatment for resistant hypertension.
Over time, high blood pressure can damage blood vessels and organs. This can lead to life-threatening events, such as stroke, heart attack, and organ damage.
Several drugs exist to manage hypertension. However, about 20% of people with the disease have resistant hypertension, which means that the drugs do not bring their blood pressure back to the healthy range.
Resistant hypertension has been linked to an increased risk of organ damage and
Some preliminary evidence suggests that diet and physical activity may lower blood pressure in people with resistant hypertension. However, to date there is a lack of high quality studies.
In a recent study, researchers at Duke University School of Medicine in Durham, North Carolina, conducted a randomized clinical trial called “Treating Resistant Hypertension Using Lifestyle Modification to Promote Health” (TRIUMPH) to examine the link between the changes. lifestyle and resistant hypertension.
They investigated how a combined 4-month diet and exercise intervention in a cardiac rehabilitation setting versus a single educational session providing the same lifestyle prescription for lowering blood pressure.
âOur results indicate that lifestyle changes in patients with resistant hypertension [â¦] can successfully lose weight, increase their physical activity and therefore lower their blood pressure and potentially reduce their risk of having a heart attack or stroke due to their hypertension â, James A. Blumenthal Ph.D. Recount Medical News Today.
Blumenthal is the study’s first lead author and the JP Gibbons Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine.
The study appears in Circulation.
The researchers recruited 140 people with resistant hypertension and an average age of 63 years. Overall, 48% of patients were female, 59% were black, 31% had diabetes, and 21% had chronic kidney disease.
All of the participants had a body mass index (BMI) of 25 kilograms per square meter or more at the start of the study and did not engage in moderate or vigorous regular physical activity.
Participants, on average, were taking 3.5 prescribed antihypertensive drugs.
The researchers randomized the participants to one of two 4-month treatment groups. The first group of 90 participants received instructions from a nutritionist on how to
The DASH diet is a flexible diet that reduces the intake of sugar and saturated fat and increases the intake of vegetables, fruits, whole grains, fish, poultry, and legumes.
Participants in the first group exercised at a cardiac rehabilitation center three times a week for 30 to 45 minutes and underwent weekly group counseling sessions to support their lifestyle changes.
The second group of 50 participants received a one-hour blood pressure management educational session from a health educator, as well as a workbook outlining an individualized diet and exercise program. The workbook included information about the DASH diet, calorie restriction, and the same exercise program as the other group.
The researchers recorded the blood pressure of the participants before, during and after the 4-month procedure. They also tracked the diet, weight and cardiovascular fitness of the participants. Participants were encouraged to continue taking any pre-existing antihypertensive medication throughout the trial, as directed by their doctor.
After the 4-month program, the supervised group saw a 12-point drop in resting systolic blood pressure compared to 7 points in the self-guided group. Systolic blood pressure refers to the pressure that blood puts on the walls of the arteries when the heart beats.
The supervised group also saw their 24-hour systolic blood pressure readings drop by 7 points, while the self-guided group saw no change in their 24-hour blood pressure readings.
Participants in the supervised group also performed well on other markers. They lost an average of 15.3 pounds (lbs) of weight over the study period, compared to 8.5 pounds in the self-guided group. This is about 7 kilograms (kg) and 4 kg, respectively.
They also increased their oxygen consumption by 14.8%, compared to 3.4% in the control group. Increased oxygen uptake is a positive indicator of cardiorespiratory function.
âBeing a randomized controlled trial (RCT), the study is considered high in the pyramid of scientific evidence,â JosÃ© M. OrdovÃ¡s, Ph.D., director of nutrition and genomics at Tufts University, MA , who was not involved in the study, says MNT.
âObviously, larger numbers and longer duration would have made the study better and would have answered additional questions. However, I consider this to be an excellent first step towards larger and longer studies. Another beauty of the study was its simplicity, which perhaps facilitated its clear answer, âhe added.
Scientists have already shown that elements of lifestyle change in the study, such as
“We were not able to determine which aspects of the intervention were primarily responsible for the hypotensive effects – whether it was improved aerobic capacity, weight loss, greater consumption of certain nutritional components of the DASH diet, salt restriction or other aspects of the intervention, âsaid Dr Blumenthal.
âWe believe that for the lifestyle program to be as effective as possible, all components of the intervention must be provided. There are a number of potential physiological mechanisms that could have affected our results, which we hope to examine in the future, âhe added.
“Based on the results presented, things did not work out according to traditional methods [cardiovascular disease] biochemical markers (inflammation, lipids, glucose) â, said Dr OrdovÃ¡s
âObviously, it didn’t work through the pathways involved in the response to the antihypertensive drugs because they were resistant to it. The most obvious element here may be weight loss. [â¦] It would be interesting to see if there was a correlation between blood pressure and weight changes, âhe continued.
The researchers concluded that people could best accomplish lifestyle changes when they were assisted by a multidisciplinary team of healthcare professionals in a cardiac rehabilitation setting.
âWhile some people can make the changes on their own, a structured program of supervised exercise and dietary modification led by a multidisciplinary team of physicians, psychologists, nutritionists and physiotherapists / exercise physiologists that found in cardiac rehabilitation programs across the country is likely to be more effective, â
– Dr Blumenthal.
The researchers note that only five study participants had systolic blood pressure greater than 160 millimeters of mercury. Therefore, the effectiveness of the intervention on lifestyle in people with more severe hypertension remains uncertain.
“Sometimes the limitations of many of these studies are their generalizability,” said Dr. OrdovÃ¡s said MNT, âYet in this case there was a good representation of minorities and gender. But, the overall environment was similar, and this needs to be replicated in other geographic and cultural areas.
âThe other obvious limitation is that it was not intended to cater for precision medicine or precision nutrition. Therefore, while the means showed an advantage towards the group undergoing the most intense intervention, this study does not reveal who benefited and who did not, âhe added.
âAll patients with hypertension should follow proper diet and exercise recommendations, but this is difficult,â said Dr Edo Paz. MNT, “In my experience, lifestyle changes are rarely enough to treat even simple hypertension.”
Dr Paz, who was not involved in the study, is vice president of medical services at K Health and a cardiologist at White Plains Hospital, NY, which is part of the Montefiore Health System.
âOverall, the results are not surprising. Cardiac rehabilitation has already been shown to be effective in preventing heart problems and death. We use it in people with certain serious heart conditions, such as people recovering from a heart attack or people hospitalized with congestive heart failure, âhe added.
âUnfortunately, only 1 in 4 eligible patients participate. Considering what we know about cardiac rehabilitation and the results of this study, we should use this tool more widely, in particular by referring more patients and ensuring that referred patients participate â,
– Dr Paz
âThe results of the TRIUMPH study suggest that policymakers should consider resistant hypertension as a new indication for cardiac rehabilitation with appropriate coverage by government agencies and private insurers,â said Dr Blumenthal. MNT.
“It is important to determine whether such lifestyle changes can be sustainable – and, if not, patients may need ‘booster’ sessions to ensure that they can maintain healthy lifestyle choices at the same time. over time, âhe concluded.