Lifestyle changes as effective as BP medications

Weight loss and exercise were effective complements to a low-salt and low-fat diet for lowering blood pressure in patients with mild hypertension in a controlled study with about 150 people.

The combined exercise, weight loss, and healthy-diet regimen led to an average systolic blood pressure reduction of 16mm Hg during 16 weeks of treatment, said at the annual meeting of the American College of Cardiology.

That is roughly equivalent to what can be achieved by treatment with one or two antihypertensive medications, observed by the chairman of cardiovascular medicine at the Cleveland Clinic, who was not involved in the study. “This is a spectacular study and shows what can be accomplished with this kind of program. We need now to generalize this” to everyday practice.

The combined lifestyle regimen also led to significant improvements in several other health measures, including aerobic capacity, left ventricular mass, vascular stiffness, and glucose tolerance, a cardiologist at the University of North Carolina, Chapel Hill said. “The results reinforce the importance of exercise and weight loss as part of a comprehensive lifestyle modification strategy in people with high blood pressure.”

The Exercise and Nutritional Interventions for Cardiovascular Health (ENCORE) study enrolled patients with a blood pressure of 130-159/85-89 mm Hg who were older than 35 years of age, had a body mass index of 25-40 kg/m2, and did not perform any regular exercise. The participants also could not be on any antihypertensive medication or have secondary hypertension, cardiac disease, diabetes, or chronic kidney disease.

The enrolled patients had an average age of 51, about two-thirds were women, about 60 percent were white and about 40 percent were black, and their average BMI was 33. Their average blood pressure was 138/85 mm Hg. The study was done at the University of North Carolina and at Duke University, Durham, NC.

Randomly assigning the patients to three treatment groups: 40 went on a diet modeled on the one used in the Dietary Approaches to Stop Hypertension (DASH) study, which included a high intake of fruits, vegetables, and low-fat dairy products, but which was not designed to result in weight loss; 49 patients began the DASH diet with a reduced calorie level designed to produced weight loss, plus a cognitive-behavioral weight-management program, and an exercise program that included three sessions a week of supervised exercise; and 49 control patients continued their usual care.

After 16 weeks of treatment, the average blood pressure reduction, compared with baseline, the study’s primary end point, was a 16/10 mm Hg drop in the total lifestyle modification group, an 11/8 mm Hg decline in the DASH diet-only patients, and a 3/4 mm Hg reduction in the control group.

The blood pressure reduction in the diet-only group was significantly reduced, compared with the controls, but the decline was even better in the diet, exercise, and weight loss patients.

The average weight loss in the triple intervention group was about 19 pounds, while people in the diet-only group did not have significant loss.

By the end of the study, patients in the complete lifestyle modification group had an average resting blood pressure of about 123/76 mm Hg.