Alan Lee Hinderliter
Lifestyle interventions may be effective replacements for antihypertensive medications in adults with overweight or obesity and hypertension, according to findings presented at the American Heart Association’s Joint Hypertension Scientific Sessions.
“Many patients with hypertension can control their blood pressure with lifestyle modifications (including adoption of a healthy diet, such as the DASH diet, exercise and weight loss) and not require treatment with medications,” Alan Lee Hinderliter, MD, associate professor of medicine at the University of North Carolina School of Medicine, Chapel Hill, told Cardiology Today.
Researchers conducted a secondary analysis of the ENCORE trial to investigate whether the Dietary Approaches to Stop Hypertension (DASH) diet, on its own or when combined with weight loss and aerobic exercise, could reduce the need for antihypertensive medication.
In total, 129 adults with overweight or obesity (BMI, 25-40 kg/m2; mean age, 54 years; 68% women; 60% white; mean BP, 138mm Hg/86 mm Hg; 19 with an estimated 10-year risk for atherosclerotic CVD risk > 10%) were randomly assigned to 16 weeks of the DASH diet and behavioral weight management (which included nutritional counseling and a behavioral weight-management program), the DASH diet on its own (which consisted of only nutritional counseling and no exercise or caloric restriction) or usual care (defined as maintaining usual exercise and dietary habits). Based on the American College of Cardiology/AHA hypertension guideline, 53% of participants should have been treated with medication.
The researchers found that BP decreased by 16mm Hg systolic/10 mm Hg diastolic with DASH plus behavioral weight management, 11 mm Hg systolic/8 mm Hg diastolic with DASH alone and 3 mm Hg systolic/4 mm Hg diastolic with the usual care.
In addition, participants with indications for antihypertensive medical therapy declined from 54% to 15% in the DASH plus behavioral weight-management group, from 51% to 23% in the DASH-only group and from 55% to 44% in the usual care group (active treatments vs. usual care, P = .001; DASH and management vs. DASH alone, P = .011).
“Some patients with mildly elevated blood pressure may, after consultation with their physicians, benefit from a trial of lifestyle modification prior to starting treatment with medications,” Hinderliter said in an interview. – by Melissa J. Webb
Hinderliter AL, et al. Abstract P388. Presented at: The American Heart Association’s Joint Hypertension Scientific Sessions; Sept. 6-9, 2018; Chicago.
Disclosures: The authors report no relevant financial disclosures.