A 4-month structured diet and exercise program significantly lowered blood pressure (BP) and body weight among patients with resistant hypertension (RH), according to study findings published in Circulation.
In the current study, researchers enrolled patients with RH in the TRIUMPH trial (ClinicalTrials.gov Identifier: NCT02342808) at Duke University School of Medicine, North Carolina, between 2015 and 2019. Study participants were randomly assigned 2:1 to receive the Center-Based Lifestyle Intervention (C-LIFE) or Standardized Education and Physician Advice (SEPA). The C-LIFE program included instruction by a nutritionist, weekly 45-minute group counseling sessions, and 30- to 45-minute exercise sessions 3 times per week. The SEPA program consisted of a 1-hour educational session about BP management and a workbook, which described best diet and exercise practices.
The primary study endpoint was clinic systolic BP. Secondary endpoints included 24-hour ambulatory BP and cardiovascular disease biomarkers, including baroreflex sensitivity, high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass.
The mean age for participants was 63±9 years; 48% were women; 59% were Black; systolic BP was 139±10 mm Hg; diastolic BP was 79±9 mm Hg, body mass index (BMI) was 36±6; and 31% had diabetes.
The participants in the C-LIFE study arm attended 94% of their diet classes and 89% of their workout sessions. Among all participants, 97% took their antihypertensive medications as instructed.
C-LIFE compared with SEPA was associated with significant reductions to systolic BP (mean, 126.8 vs 132.8 mm Hg; P =.005) and diastolic BP (mean, 73.2 vs 75.6 mm Hg; P =.034).
Among the C-LIFE and SEPA cohorts, maximum volume oxygen consumption was improved by 14.8% and 3.4% (P =.002), the average number of daily steps was 971 and 14 (P <.01), and an average of 15.3 and 8.5 lb were lost (P <.001), respectively. In addition, participants who engaged in the C-LIFE program had more favorable cardiovascular disease risk profiles (P =.027).
After treatment, the researchers reported modest reductions in BP medications in the C-LIFE group vs no changes in the SEPA group (P =.277).
This study was conducted at a single center, and findings may not be generalizable.
Overall, the 4-month diet and exercise intervention program was found to be beneficial in patients with RH with regard to lifestyle changes that decreased BP, weight, and cardiovascular disease risk profiles.
The researchers also noted, “Results of the TRIUMPH study suggest that policymakers should consider RH as a new indication for cardiac rehabilitation with appropriate coverage by governmental agencies and private insurers.”
Blumenthal JA, Hinderliter AL, Smith PJ, et al. Effects of lifestyle modification on patients with resistant hypertension: results of the TRIUMPH randomized clinical trial. Circulation. Published online September 27, 2021. doi:10.1161/CIRCULATIONAHA.121.055329