Abstract P341: BLOOD PRESSURE RESPONSES OF RICE DIET PROGRAM PATIENTS WITH MALIGNANT HYPERTENSION

Abstract

Introduction: Prior to the availability of effective anti-hypertensive medications, patients with malignant hypertension (MH) had a poor prognosis with a median survival of ~eight months. During this era, MH patients came to Durham NC to enroll in the residential Rice Diet Program at Duke (RDP), where they were placed on a low salt (5 meq/d), low protein (5% kcal), and low fat (5% kcal) diet with no anti-hypertensive medications. Examining the medical records of >16,000 RDP patients, we identified 298 patients with MH, which we define as those with documented papilledema, no documented diabetes or pseudotumor cerebri, and with a systolic BP >170 mmHg. Methods: Age at entry, gender, duration in RDP, BP and urine chloride (a measure of low-salt diet adherence) response were compared between those who stayed < vs. ≥ median duration (207.5 days) by Wilcoxon and within each group by paired t test. Linear regression was used to examine the association between these factors with the BP response from entry to weeks 4, 8, and 13, for those with continuous BP data during each period. Results: BPs and urine chloride reduced significantly in both groups and the reductions were significantly greater among those with ≥ median duration ( Table ). Age at entry had no effect on BP change except at 4 weeks. Weight had no effect while male gender, higher baseline systolic BP, and greater reduction in urine chloride were all associated with a greater BP reduction (all p<0.05). This finding was consistent at all three time points. Conclusion: A low-salt, low-protein, and low-fat diet was effective in lowering BP in those with MH. Sodium loss may be a key mechanism, but other components of the diet should also be examined.div>