Low-calorie diet may effectively ‘replace’ BP medications in type 2 diabetes
Replacing antihypertensive medications with a low-calorie diet to induce weight loss substantially reduces blood pressure and may increase mild dizziness for adults with type 2 diabetes, according to a post hoc analysis of the DiRECT study.
“The disease process linking type 2 diabetes and hypertension — with all their disabling and painful complications — can be stopped by losing about 15 kg,” Michael E.J. Lean, MA, MD, FRCP, FRSE, professor of human nutrition at the University of Glasgow, told Healio. “The main need is to enhance the long-term maintenance of substantial weight loss. There has been minimal research into weight-loss maintenance. Our new diet methods are much better, but that is still our patients’ greatest problem.”
In a post hoc analysis, Lean and colleagues analyzed changes in BP, antihypertensive medication prescriptions and symptoms from 143 participants in the intervention arm of the Diabetes Remission Clinical Trial (DiRECT; 79 men), as well as a subset of patients who discontinued antihypertensive medications at the start of total diet replacement (n = 69). The Counterweight-Plus total diet replacement provided about 830 kcal per day with automatic reductions in all nutrients, including sodium, to achieve marked negative energy balance and rapid weight loss over 12 to 20 weeks. There was regular BP monitoring and an antihypertensive medication reintroduction protocol based on current clinical guidelines.
Within the cohort, 81 participants had diagnosed hypertension and 78 (55%) were prescribed antihypertensive medications at baseline.
Researchers found that overall mean BP fell from the start of total diet replacement (week 1) and was significantly lower at week 20, as well as at 12 and 24 months. For participants with no history of hypertension at baseline, the fall in BP was “immediate and quite substantial,” the researchers wrote.
Among the 78 participants previously prescribed antihypertensive medication, 65 (83%) stopped all antihypertensive and diuretic medications per protocol; four (5%) stopped some drugs.
Among participants previously treated for hypertension and who discontinued antihypertensive medication, there were no changes in BP until week 9, when researchers observed drops in systolic BP (mean decrease, –4.5 mm Hg; P = .03) and diastolic BP (mean decrease, –2.5 mm Hg; P = .03).
Researchers observed no excessive rises in BP among participants; however, antihypertensive medications were reintroduced during total diet replacement to manage raised BP for 19 (27.5%) participants, mostly within the first 3 to 7 weeks.
Of the 69 participants who stopped some or all antihypertensive medications, 19 (28%) remained off medications at 24 months. Among the 53 participants who achieved sustained remission of type 2 diabetes at 24 months — with a mean weight loss of 11.4 kg — 31 had been previously treated for hypertension.
In a mixed-effects regression model assessing all participants who started total diet replacement, weight change was a predictor of change in BP, with a decrease of 0.53 mm Hg in systolic BP and 0.34 mm Hg in diastolic BP per kilogram lost (P < .0001 for both).
“Participants were not selected for high BP, so regression to the mean is not a factor behind the observed changes,” the researchers wrote.
The researchers noted that 51 participants reported mild to moderate dizziness, suggesting some postural hypotension. Among those, 15 recorded dizziness at baseline and nine were taking antihypertensive or diuretic medications.
“It is safe to stop antihypertensives, but BP should be monitored regularly, particularly for those taking two or more antihypertensives, as over two-thirds will require reintroduction of some medications,” the researchers wrote. “Long-term support to maintain weight loss is vital.”