ORLANDO — Weight loss and exercise were effective complements to a low-salt, low-fat diet for driving down blood pressure in patients with mild hypertension in a controlled study of nearly 150 people.
The combined exercise, weight loss, and healthy-diet regimen led to an average systolic blood pressure reduction of 16 mm Hg during 16 weeks of treatment, Dr. Alan L. Hinderliter said at the annual meeting of the American College of Cardiology.
That amount of blood pressure effect is roughly equivalent to what can be achieved by treatment with one or two antihypertensive medications, said Dr. Steven Nissen, 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, Dr. Nissen said. He suggested applying the combined lifestyle regimen to patients who need multiple antihypertensive medications to see if it could eliminate the need for one or more drugs.
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, said Dr. Hinderliter, a cardiologist at the University of North Carolina, Chapel Hill. “The results reinforce the importance of exercise and weight loss as part of a comprehensive lifestyle modification strategy in people with high blood pressure,” he said.
The Exercise and Nutritional Interventions for Cardiovascular Health (ENCORE) study enrolled patients with a blood pressure of 130-159/85-99 mm Hg, aged older than 35 years, with a body mass index of 25-40 kg/m
Dr. Hinderliter and his associates randomly assigned the patients to three treatment groups. Forty-six went on a diet modeled on the one 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. Forty-nine patients began the DASH diet with a reduced calorie level designed to produce weight loss, plus a cognitive-behavioral weight-management program, plus an exercise program that included three sessions per week of supervised exercise. Forty-nine control patients continued their usual care. The DASH diet used by both intervention groups led to significantly reduced intake of sodium and fat and a significantly increased intake of potassium and magnesium. Patients in both intervention groups had a high level of compliance with their regimens throughout the study.
After 16 weeks of treatment, the average blood pressure reduction, compared with baseline, the study's primary end point, was 16/10 mm Hg in the total lifestyle modification group, 11/8 mm Hg in the DASH diet-only patients, and 3/4 mm Hg in the control group. Blood pressure 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, Dr. Hinderliter reported. The average weight loss in the triple-intervention group was 19 pounds. Those in the diet-only group did not have significant weight loss.
By the end of the study, patients in the complete lifestyle modification group had an average resting blood pressure of 123/76 mm Hg.
The study was funded by the National Heart, Lung, and Blood Institute and Duke University. Dr. Hinderliter said he and his associates had no financial relationships to report.
Blood pressure reduction was most significant in the diet, exercise, and weight-loss group. DR. HINDERLITER