Key result
A 6-month intensive multidisciplinary lifestyle intervention significantly reduced 24-hour systolic blood pressure by a mean of 14.0 mmHg from baseline in patients with resistant hypertension.
Why the study?
Resistant hypertension is closely linked to excess weight and high cardiovascular risk, raising the question of whether lifestyle interventions and invasive weight-loss procedures should be considered in management.
Do multidisciplinary lifestyle interventions or bariatric surgery improve blood pressure and reduce medication burden in patients with resistant hypertension and obesity?
Cohort (n=78)
Yes
Do multidisciplinary lifestyle interventions or bariatric surgery improve blood pressure and reduce medication burden in patients with resistant hypertension and obesity?
Mean Difference: -14
Absolute Event Rate: 124.3% vs 138.3%
p-value: p=1.6x10-5
Multidisciplinary lifestyle interventions and bariatric surgery may significantly improve blood pressure control and reduce medication burden in patients with resistant hypertension and obesity.
Supports exploring invasive procedures for resistant hypertension; leaves open efficacy and safety confirmation in randomized trials.
Resistant hypertension renders patients refractory to pharmacological treatment and is closely associated with excess weight and high cardiovascular risk. Resistant hypertension and obesity-associated hypertension share highly interrelated and interacting pathogenic mechanisms exacerbated by adiposity that propagate end organ damage including chronic kidney disease and cardiovascular disease. Perhaps it is time to contemplate in the overall management of hypertension, invasive procedures focused on weight loss. Lifestyle interventions improved results from pharmacotherapy alone in a cohort of patients with resistant hypertension. After 6 months of intensive multidisciplinary care, we found significant reductions in blood pressure, body mass index, and antihypertensive medication burden with improvement in cardiovascular disease biomarkers. Increased physical activity and weight loss appeared to be significant factors. Weight-loss drugs are generally ineffective but the impact of laparoscopic sleeve gastrectomy in another cohort of patients with obesity grade 3 and hypertension, was relevant with hypertension remission in more than 50% of cases and significant reductions in blood pressure and medication burden in those who remained hypertensive. Our results suggest the need to define in future studies and selected patients the potential role of combining medical multidisciplinary care with surgical interventions in the management of patients with resistant hypertension and high cardiovascular risk.
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Espinel et al. (2022) conducted a cohort in Resistant hypertension and obesity-associated hypertension (n=78). Intensive multidisciplinary lifestyle intervention vs. Baseline was evaluated on 24-hour systolic blood pressure (MD -14.0 mmHg, p=1.6x10-5). A 6-month intensive multidisciplinary lifestyle intervention significantly reduced 24-hour systolic blood pressure by a mean of 14.0 mmHg from baseline in patients with resistant hypertension.
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