Abstract P388: Lifestyle Interventions Reduce the Need for Guideline-Directed Antihypertensive Medication

Abstract

Introduction: The 2017 ACC-AHA Hypertension Guideline recommends lifestyle modification in the initial treatment of hypertension, and therapy with medications based on a threshold blood pressure determined by overall cardiovascular risk. In this secondary analysis of the ENCORE trial, we examined the effects of the DASH diet alone and in combination with weight loss and aerobic exercise on the indications for antihypertensive medication. Methods: Participants included 129 overweight or obese (BMI=25-40 kg/m 2 ) men and women between the ages of 40 and 80 years who had blood pressure 130-160/80-99 mmHg and who were not being treated with antihypertensive medications. Participants were randomized to 16 weeks of DASH diet plus behavioral weight management (consisting of nutritional counseling and a behavioral weight management program; DASH+WM), DASH diet alone (consisting of nutritional counseling without exercise or caloric restriction; DASH), or usual care controls (maintenance of usual exercise and dietary habits; UC). Results: The participants averaged 53.5±8.8 years of age; 68% (88 of 129) were female, and 60% (77 of 129) were white. Nineteen had an estimated 10-year atherosclerotic cardiovascular disease risk ≥ 10% by the Pooled Cohort Equations, and 1 had diabetes. Blood pressure averaged 138±9/86±6 mmHg. Criteria for treatment with antihypertensive medications, as defined in the 2017 ACC-AHA Hypertension Guideline, were present in 53% (68 of 129). Blood pressure fell by 16/10 mmHg in DASH+WM, 11/8 mmHg in DASH, and 3/4 mmHg in UC. The percentage of subjects with indications for antihypertensive medical therapy fell from 54% (25 of 46) to 15% (7 of 46) in the DASH+WM group and from 51% (20 of 39) to 23% (9 of 39) in the DASH group; and did not significantly change (55% [24 of 44] to 48% [21 of 44]) in the UC group (p = 0.001 for active treatments vs UC; p = 0.011 for DASH+WM vs DASH alone). Conclusions: In overweight or obese men and women with hypertension, lifestyle interventions dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated.