Diet change, exercise can help

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 DASH diet in addition to calorie and sodium reductions.

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.

“Being a randomized controlled trial (RCT), the study is considered high in the pyramid of scientific evidence,” José M. Ordovás, Ph.D., director of nutrition and genomics at Tufts University, MA , who was not involved in the study, says MNT.

“Obviously, 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, ”he added.

Scientists have already shown that elements of lifestyle change in the study, such as reduced salt intake, weightloss, and exercise, can lower blood pressure. Which of these plays the most important role in lowering blood pressure, however, remains unclear.

“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, ”said Dr Blumenthal.

“We 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, ”he added.

“Based on the results presented, things did not work out according to traditional methods [cardiovascular disease] biochemical markers (inflammation, lipids, glucose) ”, said Dr Ordovás

“Obviously, 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. […] It would be interesting to see if there was a correlation between blood pressure and weight changes, ”he 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.

“While 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, ”

– 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. Ordovás said MNT, “Yet 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.

“The 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, ”he added.

“All patients with hypertension should follow proper diet and exercise recommendations, but this is difficult,” 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.

“Overall, 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, ”he added.

“Unfortunately, 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 ”,

– Dr Paz

“The 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,” 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, ”he concluded.