Healthy changes in diet, activity improved treatment-resistant high
blood pressure

Date:
September 27, 2021
Source:
American Heart Association
Summary:
A healthy eating plan, weight loss and improved aerobic fitness
can significantly reduce blood pressure and improve heart health
in people with resistant hypertension -- a condition in which
blood pressure remains high despite the use of three or more
antihypertensive medications.



FULL STORY ========================================================================== People with treatment-resistant hypertension successfully reduced their
blood pressure by adopting the Dietary Approaches to Stop Hypertension
(DASH) eating plan, losing weight and improving their aerobic fitness by participating in a structured diet and exercise program at a certified
cardiac rehabilitation facility, according to new research published
today in the American Heart Association's flagship journal Circulation.


========================================================================== Uncontrolled high blood pressure (130/80 mm Hg or higher) despite
the use of three or more medications of different classes including
a diuretic to reduce blood pressure is a condition known as resistant hypertension. Although estimates vary, resistant hypertension likely
affects about 5% of the general global population and may affect 20%
to 30% of adults with high blood pressure.

Resistant hypertension is also associated with end-organ damage and a
50% greater risk of adverse cardiovascular events, including stroke,
heart attack and death.

Diet and exercise are well-established treatments for high blood
pressure. In June 2021, the American Heart Association advised that
physical activity is the optimal first treatment choice for adults with
mild to moderately elevated blood pressure and blood cholesterol who
otherwise have low heart disease risk.

This new study, Treating Resistant Hypertension Using Lifestyle
Modification to Promote Health (TRIUMPH), is the first to evaluate
the impact of lifestyle modifications in people with resistant
hypertension. Researchers found that behavioral changes, including
regular aerobic exercise, adoption of the DASH (Dietary Approaches to
Stop Hypertension) diet, reducing salt consumption and losing weight,
can lower blood pressure significantly and improve cardiovascular health
in people with resistant hypertension. The DASH eating plan is rich in
fruits, vegetables, low-fat dairy products and limited salt, and aligns
with the American Heart Association's nutrition recommendations.

The four-month clinical trial involved 140 adults with resistant
hypertension (average age 63; 48% women; 59% Black adults; 31% with
type 2 diabetes; and 21% with chronic kidney disease). Participants
were randomly divided into two groups -- 90 participants received
weekly dietary counseling and exercise training in an intensive,
supervised cardiac rehabilitation setting three times a week. The other
50 participants received a single informational session from a health
educator and written guidelines on exercise, weight loss and nutritional
goals to follow on their own.

Researchers found:
* The participants in the supervised program had about a 12-point
drop in
systolic blood pressure, compared to 7 points in the self-guided
group.

Systolic blood pressure (the first number in a blood pressure
reading) indicates how much pressure blood is exerting against
artery walls when the heart beats and is recognized as a major
risk factor for cardiovascular disease for adults ages 50 and older.

* Blood pressure measures captured through 24 hours of ambulatory
monitoring during a typical day revealed that the group in the
supervised lifestyle program had a 7-point reduction in systolic
blood pressure, while the self-guided group had no change in
blood pressure.

* Participants in the supervised program also had greater improvements
in
other key indicators of heart health, suggesting that they had a
lower risk of a heart event in the future.

"Our findings showed lifestyle modifications among people with resistant hypertension can help them successfully lose weight and increase their
physical activity, and as a result, lower blood pressure and potentially
reduce their risk of heart attack or stroke," said James A. Blumenthal,
Ph.D., first and senior author of the study, and J.P. Gibbons Professor
of Psychiatry and Behavioral Sciences at Duke University School of
Medicine in Durham, North Carolina. "While some people can make lifestyle changes on their own, a structured program of supervised exercise and
dietary modifications conducted by a multidisciplinary team of health
care professionals in cardiac rehabilitation programs is likely more effective."


========================================================================== Blumenthal noted that the success of the supervised program doesn't mean
people with resistant hypertension can stop taking their medications;
however, it suggests that they may want to talk with their physicians
about possibly reducing the dosages or altering their medications based
upon their lowered blood pressure values.

The study was conducted at a single institution -- Duke University School
of Medicine -- so findings may not be generalizable to broader groups
of people.

However, the intensive, structured, supervised part of the study
occurred at several representative cardiac rehabilitation centers in
central North Carolina, with educational and cultural diversity well represented. Researchers believe the program could be implemented
with success at similar cardiac rehabilitation centers throughout the
county. Also, the study's impact beyond the four months of monitoring is limited by whether participants who made significant lifestyle changes
will maintain them. "The benefits of the lifestyle modifications may
be reduced unless the healthy lifestyle habits can be maintained,"
Blumenthal said.

"The most important point is that it is not too late to lower blood
pressure by making healthy lifestyle choices," he said. "Adopting
a healthy lifestyle pays huge dividends, even for people whose blood
pressure remains elevated despite being on three or more antihypertensive medications." American Heart Association volunteer expert Bethany
Barone Gibbs, Ph.D., FAHA, noted that this data gives clinicians another evidence-based tool for helping patients with resistant hypertension.

"Though we usually think about recommending lifestyle changes like losing weight and getting more physical activity before starting medications,
this study provides important reinforcement that adding lifestyle changes
in conjunction with medications -- and when medications alone are not
doing the job -- is an effective strategy," said Gibbs, an associate
professor in the department of health and human development and clinical
and translational sciences at the University of Pittsburgh. "Also exciting
is that Blumenthal, et. al., used a cardiac rehab model, which can be duplicated in many settings." Gibbs, chair of the statement writing group
of the Association's June 2021 scientific statement on lifestyle treatment
for hypertension, urged patients to commit to lifestyle changes -- losing
5% to 10% of their bodyweight, greater adherence to the DASH-style diet,
and increasing steps by at least 1,000 per day can yield health benefits.

========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. James A. Blumenthal, Alan L. Hinderliter, Patrick J. Smith,
Stephanie
Mabe, Lana L. Watkins, Linda Craighead, Krista Ingle, Crystal
Tyson, Pao- Hwa Lin, William E. Kraus, Lawrence Liao, Andrew
Sherwood. Effects of Lifestyle Modification on Patients With
Resistant Hypertension: Results of the TRIUMPH Randomized Clinical
Trial. Circulation, 2021; DOI: 10.1161/CIRCULATIONAHA.121.055329 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210927092147.htm

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