Lifestyle changes for patients with high blood pressure resistant to medications

This study looked at the effects of diet and lifestyle changes for people with high blood pressure who did not respond to medication. It found that a four-month counseling program led to significant improvement in diet and exercise, blood pressure, and heart health.

Uncontrolled high blood pressure leads to cardiovascular (CV) events such as heart attack and stroke. Regular exercise improves the ability of the heart to pump efficiently, and of the arteries to adjust elastically to faster blood flow. The food we eat affects whether fatty deposits build up in the arteries.

Better diet and exercise are often recommended as the first step in treating high blood pressure. However, medications are the standard treatment for high BP. There are several types of medications to lower BP. However, 20% to 30% of adults with high BP do not respond to medication. This is referred to as resistant hypertension. It is not clear whether diet and exercise can control BP for people with RH.

This study included 140 people with resistant high BP. The patients’ high BP had not responded to at least three types of medication. Half of the patients were randomly assigned to the C-LIFE program and the other half to a comparison group. Both groups were recommended to exercise regularly and follow the DASH diet, which is low in salt and emphasizes vegetables and whole grains. The C-LIFE intervention included weekly group sessions with a psychologist to aid in changing lifestyle habits. It also included exercise at a cardiac rehabilitation facility three times a week. The control (comparison) group was given a 1-hour educational session and a workbook on the DASH diet.

Maximal aerobic capacity, or VO2 max, is a measurement of aerobic fitness. Compared to the control group, the C-LIFE participants’ aerobic fitness increased significantly (14.8% vs. 3.4% improvement in VO2 max). C-LIFE participants also significantly increased their daily vegetables from 3.7 to 4.4 servings. While both groups lost weight, the C-LIFE participants had more weight loss on average (15.3 vs. 8.5 lbs).

BP rises and falls as the heart beats. Systolic refers to the higher BP value and diastolic to the lower value. Both types of BP are important, although systolic BP may have more importance for heart health. Both BP values were significantly lower for C-LIFE participants. The average C-LIFE systolic BP was 126.8 mmHg, compared to 132.8 mmHg.

This study found that weekly counseling and exercise led to better diet, improved aerobic fitness, and lowered BP for people with resistant high BP.

This paper did not report on patients after the 4-month C-LIFE program ended, or their progress in maintaining lifestyle changes.