Lifestyle changes can help with resistant hypertension. Researchers recently investigated whether lifestyle changes could lower blood pressure in people with resistant hypertension. Their results suggest that supervised lifestyle changes, including dietary modifications, group counseling and a cardiac rehabilitation exercise program, provide similar results to blood pressure-lowering medication.

The World Health Organization (WHO) estimates that 1.28 billion adults aged 30 to 79 worldwide suffer from high blood pressure, or hypertension. Over time, high blood pressure can damage blood vessels and organs. It can lead to life-threatening events, such as stroke, heart attack, and organ damage. There are several medications available to manage hypertension. However, about 20% of people with this condition have resistant hypertension, which means that medications do not bring their blood pressure back into the healthy range.

Diet and physical activity for 4 months

Resistant hypertension is linked to an increased risk of organ damage and a 50% mortality rate compared to people with treatable hypertension. Some preliminary data suggests that diet and physical activity may lower blood pressure in people with resistant hypertension. However, to date, there is a lack of quality studies. In a recent study, researchers at Duke University School of Medicine in Durham (North Carolina, USA) conducted a randomized clinical trial titled “Treating Resistant Hypertension Using Lifestyle Modification to Promote Health” (TRIUMPH) to examine the link between lifestyle changes and resistant hypertension.

They investigated how a four-month combination diet and exercise intervention delivered as part of cardiac rehabilitation could reduce blood pressure compared to a single education session providing the same prescription of way of life. The results indicate that lifestyle modifications in patients with resistant hypertension may lead to weight loss, increased physical activity and, therefore, lower blood pressure and potentially reduce the risk of heart attack or stroke due to high blood pressure. The study is published in Circulation.

Randomized trial

The researchers recruited 140 people with resistant hypertension and aged 63 on average. Overall, 48% of patients were female, 31% were diabetic, and 21% had chronic kidney disease. All participants had a body mass index (BMI) of 25 kilograms per square meter or more at the start of the study and did not engage in regular moderate or vigorous physical activity. Participants took an average of 3.5 prescribed blood pressure medications.

Researchers randomly assigned participants to one of two 4-month treatment groups. The first group of 90 participants received instructions from a nutritionist on the DASH diet. as well as calorie and sodium reductions. The DASH Diet is a flexible eating plan that reduces sugar and saturated fat intake and increases intake of vegetables, fruits, whole grains, fish, poultry and legumes. Participants in the first group exercised at a cardiac rehabilitation center three times a week for 30 to 45 minutes and had weekly group counseling sessions to help them make lifestyle changes.

The second group of 50 participants received a one-hour educational session on blood pressure management, led by a health educator, as well as a workbook outlining a diet and exercise program individualized. The workbook included information about the DASH diet, calorie restriction, and the same exercise program as participants in the other group.

Lower blood pressure, weight loss and better breathing

The researchers recorded the participants’ blood pressure before, during and after the four-month intervention. They also tracked participants’ diet, weight, and cardiovascular fitness. Participants were encouraged to continue taking any pre-existing blood pressure medication throughout the trial, as instructed by their doctor.

After the 4-month program, the supervised group saw their resting systolic blood pressure drop by 12 points, compared to 7 points in the self-guided group. Systolic blood pressure is the pressure exerted by blood on the walls of the arteries when the heart beats. The supervised group also saw their 24-hour systolic blood pressure drop by 7 points, while the self-guided group saw no change in their 24-hour blood pressure.

Participants in the supervised group also performed well on other criteria. They lost an average of 7 kg of weight during the study period, compared to 4 kg in the self-guided group. They also increased their oxygen uptake by 14.8%, compared to 3.4% in the control group. Increased oxygen consumption is a positive indicator of cardiorespiratory function.

Psychological mechanisms

Scientists have already shown that some elements of the lifestyle changes in the study, such as reducing salt intake, have a positive effect on health. Weight loss
and exercise can lower blood pressure. However, it is still unclear which of these elements plays the most important role in lowering blood pressure. The researchers believe that for the lifestyle program to be most effective, all elements of the intervention must be provided. There are a large number of potential physiological mechanisms that could have affected our results.

Although some people can make the changes on their own, a structured program of supervised exercise and diet modification conducted by a multidisciplinary team of physicians, psychologists, nutritionists and exercise physiotherapists found in cardiac rehabilitation programs nationwide is probably more effective.


WHO: Hypertension

Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients

Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial

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