期刊
AMERICAN JOURNAL OF HYPERTENSION
卷 34, 期 10, 页码 1100-1107出版社
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpab090
关键词
antihypertensive drugs; blood pressure; DASH diet; hypertension; lifestyle modification
资金
- National Heart, Lung, and Blood Institute [HL074103]
- General Clinical Research Center [M01-RR-30]
- National Center for Research Resources [5UL1RR024128]
- National Institutes of Health Roadmap for Medical Research
The study found that lifestyle modifications can reduce calculated CVD risk and significantly decrease the number of individuals who need antihypertensive medication according to guidelines.
BACKGROUND The 2017 ACC-AHA Hypertension Guideline recommends initiation of antihypertensive drug therapy based on blood pressure (BP) and an assessment of global cardiovascular disease (CVD) risk, but intensive lifestyle modification may lower BP to below recommended thresholds for treatment in some patients. METHODS We examined the effects of lifestyle modification on calculated CVD risk and on the indications for BP-lowering medications in individuals with untreated hypertension. Participants included 144 adults with BP 130-160/80-99 mm Hg who were randomized to 16 weeks of DASH (Dietary Approaches to Stop Hypertension) diet plus behavioral weight management (DASH + WM), DASH diet alone (DASH), or Usual Care. RESULTS The mean age of the study cohort was 52.0 years; the average baseline BP was 138 9/86 +/- 6 mm Hg. The 10-year CVD risk, as calculated by the Pooled Cohort Equations, was 5.7%. The adjusted 10-year risk fell to 4.4% in the DASH + WM group and to 5.0% in the DASH arm, but was not significantly changed (5.7%) in the Usual Care controls. The percentages of participants with guideline-based indications for antihypertensive drugs fell from 51% to 18% in the DASH + WM group and from 48% to 22% in the DASH group; and did not change significantly (49% to 44%) in the Usual Care group (P = 0.010 for the active intervention groups vs. Usual Care; P = 0.042 for DASH + WM vs. DASH). CONCLUSIONS These data demonstrate that in men and women with mildly elevated BP, lifestyle interventions can lower the calculated CVD risk and dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated.
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