Lifestyle Change Curbs Need for Antihypertensive Agents

Megan Brooks

September 21, 2018

CHICAGO — For many men and women with high blood pressure, lifestyle interventions can reduce the need for antihypertensive medications, a secondary analysis of the ENCORE study suggests.

"A motivated hypertensive patient who embraces lifestyle modification strategies may not require treatment with medications," Alan Hinderliter, MD, University of North Carolina, Chapel Hill, told | Medscape Cardiology.

The study was presented September 8 during the American Heart Association Joint Hypertension 2018 Scientific Sessions.

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Hypertension Guideline recommends lifestyle modification in the initial treatment of hypertension.

Hinderliter and colleagues examined the effects of lifestyle changes on the need for antihypertensive medication in participants in the Exercise and Nutrition Intervention for Cardiovascular Health (ENCORE) study.

The 129 participants were overweight or obese adults (body mass index, 25 - 40 kg/m2) with elevated blood pressure (range, 130–160/80–99 mm Hg; average, 138/86 mm Hg) who were not being treated with antihypertensive medication.

They were randomly allocated to 16 weeks of the low-sodium, low-fat Dietary Approaches to Stop Hypertension (DASH) diet plus behavioral weight management  which consisted of nutritional counseling and a behavioral weight management program (DASH+WM); the DASH diet alone, which consisted of nutritional counseling without exercise or caloric restriction (DASH); or usual care, maintenance of usual exercise, and dietary habits (UC).

By the pooled cohort equations, 19 participants had an estimated 10-year atherosclerotic cardiovascular disease risk of at least 10%. More than half the participants (68 of 129; 53%) met the criteria for antihypertensive medications dexcribed in the 2017 ACC/AHA guideline.

The DASH diet alone led to a decrease in blood pressure, and the addition of a weight management intervention led to a significant incremental drop in blood pressure, the researchers found.

BP Change by Lifestyle Intervention
Intervention Average Change in Systolic/Diastolic BP (mm Hg)
DASH+WM –16/–10
DASH –11/–8
UC –3/–4

The percentage of adults with indications for antihypertensive medical therapy fell from 54% to 15% in the DASH+WM group and from 51% to 23% in the DASH group. In the UC group, there was no significant change (55% to 48%).

"This study is important and aligns very well" with the revised hypertension guidelines that emphasize lifestyle modification in the initial treatment of high blood pressure, AHA spokesperson Richard Becker, MD, University of Cincinnati, told | Medscape Cardiology.

"If we follow these guidelines, it means that in the very earliest stages of elevated blood pressure, hopefully we could prevent people from going from that elevated to stage 1 hypertension with lifestyle modification," said Becker.

The study was funded by the National Institutes of Health. The authors and Becker have disclosed no relevant financial relationships.

American Heart Association Joint Hypertension 2018 Scientific Sessions (HYP): Poster 388. Presented September 8, 2018.


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