Written by Chrystal Moulton, Staff Writer. Intense lifestyle treatment significantly improved blood pressure and pathophysiological markers of arterial stiffness and endothelial dysfunction in patients with stage 1 essential hypertension.
Essential hypertension is a key risk factor in CVD and is directly associated with the incidence of stroke and heart attacks 1,2. Vascular dysfunction, which precedes atherosclerosis, occurs in the development of both essential hypertension and CVD 3,4.
In randomized, single blind, parallel study, researchers recruited 91 outpatients with stage I essential hypertension 5. The study was prospective and investigated the effect of six-month intense lifestyle treatment versus standard care in the treatment of stage 1 essential hypertension. Patients were divided into two groups based on level of care:
- Standard care group: served as the control
- Received standard guidance according to the European Society of Hypertension guidelines
- No personalized dietary schedules or further sessions thru out the 6 month trial
- Intensive lifestyle treatment: served as the intervention group
- Received an hour-long session on the guidance according to European Society of Hypertension guidelines with a registered dietitian
- Personalized diet plan created with an hour-long nutrition education session set every month thru out the 6 month trial
Of the 91 patients recruited, 81 were randomly allocated to one of the two groups listed above. Baseline measurements include: blood pressure, physical activity (via IPAQ or International Physical Activity Questionnaire), fasting glucose, urea, uric acid , creatinine, TC, HDL, LDL, SGOT, SGPT, Na, K, ADMA, urine analysis (Na, K, creatinine, microalbumin), carotid stiffness, carotid intima media thickness, weight, waist/hip circumference, body composition analysis, basal metabolic rate, and 3 day diet recall. At 3 months, patients returned to the office for follow up testing which included blood pressure, weight, waist/hip circumference, blood and urine analysis and 3-day diet recall. At 6 months, patients underwent the same measurements conducted at baseline. Primary outcome includes changes in BP, indices of arterial stiffness, and subclinical markers of atherosclerosis and lipid profile (i.e. cIMT and TC, TG, HDL, LDL, respectively). Secondary outcomes were changes in weight, waist/hip circumference, physical activity, dietary inflammatory index (based on 3-day diet recalls), and urinary Na and K losses.
Final sample of 76 patients were included in the trial, 38 in each group. After 6 months, urinary Na excretion was significantly lower in the intervention group compared to the control and baseline measures (ILT: 139.1± 42.4 baseline vs. 87.6± 24.2 at 6mos, p≤ 0.001; vs. Control: 153.8± 75.4 at 6mos, p≤ 0.001). Systolic blood pressure was significantly improved in the intervention group compared to baseline and control (taken in office- ILT baseline: 142.8± 4.1 and Control 6mos: 135.7± 9.5 vs. ILT 6mos: 123.3± 8.9, p≤ 0.001). Diastolic blood pressure was significantly improved in the intervention group (taken in office- ILT baseline: 90.9± 9.1 and Control 6mos: 86.4± 9.1 vs. ILT 6mos: 82.2± 7.6, p≤ 0.001). Carotid stiffness and index for atherosclerosis was significantly improved compared to baseline and control (Mean cIMT (mm)- ILT 6mos: 0.58± 0.08 vs control 6mos: 0.63± 0.1, p≤ 0.05; mean β-stiffness index- ILT baseline: 8.4± 2.3 vs. 6.9± 1.6 (6mos)*; vs. control (6mos): 8.5± 2.8, *p≤ 0.01 for both comparisons). Endothelial function was also significantly improved compared to both baseline ILT and control (ILT: 1.02± 0.12 vs 0.59± 0.12, p≤ 0.001; vs. control (6mos): 1.0± 0.32, p≤ 0.001). Significant improvement was also observed in serum TC (ILT: 213.6± 39.7 mg/dL vs 177± 20.3 mg/dL, p≤ 0.001; versus control: 210.3± 37.1 mg/dL vs. 207.7± 38.8 mg/dL, p≤ 0.001) TG (ILT: 129.6± 28.7 mg/dL vs. 95.3± 39.5 mg/dL, p≤ 0.001; versus control: 141.6± 25.5 mg/dL vs. 119.5± 55.9 mg/dL, p≤ 0.05), LDL (ILT: 147.5± 36.9mg/dL vs. 119± 20.9mg/dL, p≤ 0.001; versus control: 138.5± 33.7mg/dL vs. 136± 30.5mg/dL, p≤ 0.01) compared to baseline and control, respectively.
The study showed adherence to intense lifestyle modification improved vascular and endothelial function, blood pressure, and lipid profile in patients with stage I essential hypertension compared to usual care. Further studies are required to see if benefits could extend to patients with higher stages of essential hypertension.
Source: Vamvakis, Anastasios, Eugenia Gkaliagkousi, Antonios Lazaridis, Maria G. Grammatikopoulou, Areti Triantafyllou, Barbara Nikolaidou, Nikolaos Koletsos et al. “Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial.” Nutrients 12, no. 5 (2020): 1326.
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/)
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Posted August 11, 2020.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
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- Vamvakis A, Gkaliagkousi E, Lazaridis A, et al. Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial. Nutrients. 2020;12(5).
