Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial

Abstract

Introduction: Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD). Hypothesis: We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension. Methods: The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR <60 mL/min/1.73 m 2 or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index. Results: Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers. Conclusions: A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.