Key result
DASH diet plus weight management reduces indications for antihypertensive drugs by ~59% versus usual care.
Why the study?
Intensive lifestyle modification may lower BP below recommended treatment thresholds under the 2017 ACC-AHA guideline based on BP and global CVD risk.
Do lifestyle interventions (DASH diet with or without weight management) reduce calculated CVD risk and the need for antihypertensive medication in adults with untreated mildly elevated blood pressure?
RCT (n=144)
randomized
Do lifestyle interventions (DASH diet with or without weight management) reduce calculated CVD risk and the need for antihypertensive medication in adults with untreated mildly elevated blood pressure?
Absolute Event Rate: 18% vs 44%
p-value: p=0.010
Intensive lifestyle interventions, including the DASH diet and weight management, significantly reduce calculated 10-year CVD risk and the proportion of patients requiring guideline-directed antihypertensive medication.
Supports DASH ± weight management to reduce antihypertensive needs in mild hypertension; extends RCT evidence for lifestyle as first-line therapy.
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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Hinderliter et al. (2021) conducted an RCT in untreated hypertension (n=144). DASH diet plus behavioral weight management or DASH diet alone vs. Usual Care was evaluated on Guideline-based indications for antihypertensive drugs (p=0.010). A 16-week intervention of DASH diet plus weight management reduced the percentage of patients with indications for antihypertensive drugs to 18%, compared to 44% with usual care (P=0.010).
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