Structured life-style program for resistant hypertension improves blood strain, a number of biomarkers

September 27, 2021

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A 4-month cardiac rehab program for treatment-resistant hypertension that focused on diet, exercise, and weight loss resulted in greater improvements in blood pressure in both the office and the 24-hour outpatient setting compared to a single training session.

According to the results of the TRIUMPH study published in Circulation, the 4-month center-based lifestyle intervention also improved biomarkers for CVD, including resting baroreflex sensitivity, high-rate heart rate variability, and flow-mediated dilation.

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“It is surprising that lifestyle change in patients with resistant hypertension (RH) has not been thoroughly studied.” James A. Blumenthal, PhD, Professor of Psychiatry and Behavioral Sciences, JP Gibbons Distinguished Professor of Psychiatry I and Assistant Professor of Medicine at Duke University Medical Center, and colleagues wrote.

James A. Blumenthal

“Although estimates vary, RH is thought to affect 5% of the general population and 20 to 30% of hypertensive adults, with even higher rates in adults with risk factors for cardiovascular disease such as diabetes or chronic kidney disease,” the researchers write. “RH is a particularly important designation because it is associated with a higher prevalence of end organ damage and a 50% higher risk of adverse cardiovascular events, including stroke, myocardial infarction and death, compared to controlled blood pressure. Therefore, it is timely and important to identify effective treatments to lower blood pressure in patients with RH. “

To address this issue, researchers conducted the TRIUMPH randomized clinical trial, which evaluated a 4-month center-based lifestyle intervention with nutritional counseling, behavioral weight management, and exercise versus a single training session that provided the same lifestyle information as well as written guidelines on specific exercises, Weight loss and nutritional goals.

The researchers recruited 140 patients (mean age 63 years; 48% women; 59% blacks; 31% with diabetes; 21% with chronic kidney disease) who were randomly assigned to the 4-month center-based intervention or a single counseling session for adjuvant therapy when treatment-resistant Hypertension.

Results from TRIUMPH

The primary endpoint was clinical systolic blood pressure. Secondary endpoints were 24-hour ambulatory BP and CVD biomarkers, including baroreflex sensitivity, radiofrequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass.

Blumenthal and colleagues observed that the reduction in systolic blood pressure in the clinic was greater than that of participants in the 4-month center-based lifestyle intervention (-12.5 mm Hg; 95% CI, -14.9 to -10.2) who were assigned to the individual counseling session (–7.1 ​​mm Hg; 95% CI, 10.4 to –3.7; P = 0.005). The patients’ 24-hour ambulatory systolic blood pressure was reduced in the 4-month center-based lifestyle intervention (-7 mm Hg; 95% CI, -8.5 to -4), but not in the individual counseling session (-0.3 mm Hg ; 95% CI, -4 to 3.4; P = 0.001).

According to the study, the 4-month center-based intervention also resulted in greater improvement in resting baroreflex sensitivity (2.3 vs. -1.1 ms / mm Hg; p <-0.2 ln ms2; P <0.001) and flow-mediated dilation (0 , 3% vs. –1.4%; P = 0.022) compared to a single counseling session. The researchers reported no significant differences for pulse wave velocity (P = 0.958) or LV mass (P = 0.596) results.

“Our results showed that lifestyle changes in people with resistant hypertension can help them successfully lose weight and increase physical activity, thereby lowering blood pressure and potentially reducing their risk of heart attack or stroke,” said Blumenthal in a press release . “While some people can make lifestyle changes on their own, a structured program of supervised exercise and diet changes conducted by a multidisciplinary team of health professionals in cardiac rehabilitation programs is likely to be more effective.”

A replicable model

“While we usually think of recommending lifestyle changes such as weight loss and more physical activity before starting medication, this study provides important confirmation that adding lifestyle changes to medication – and when medication alone is not enough – is an effective strategy. ” Bethany Barone Gibbs, PhD, FAHA, Associate Professor in the Department of Health and Human Development and Clinical and Translational Sciences at the University of Pittsburgh and AHA Volunteer Expert, said in the press release. “It is also exciting that Blumenthal et al. have used a cardiac rehab model that can be duplicated in many situations. “

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