Abstract
Lifestyle modification is an important component of essential hypertension (EH) therapy. The aim of the Hypertension Intensive Nutrition Treatment (HINTreat) parallel, randomized controlled trial was to examine the effect of a 6-month intensive lifestyle treatment (ILT) (diet plus exercise with monthly visits) compared to the usual care. A total of 76 adults with stage 1 EH were randomized (38 in each group). Dietary analysis, anthropometry, physical activity, biochemical and urine profile, blood pressure (BP), asymmetric dimethylarginine (ADMA), central hemodynamics, β-stiffness index and carotid intima media-thickness were evaluated. The dietary inflammatory index (DII) was calculated for each participant from the intake of 29 nutrients/food components. At the end of the trial, participants in the ILT group reduced their 24h urinary Na excretion (p ≤ 0.001), daytime systolic BP (p ≤ 0.048) and mean carotid β-stiffness index (p ≤ 0.005) and ameliorated their lipidemic profile compared to the standard care. Univariate analysis for the total sample showed a strong association between DII and ADMA levels (β = 0.089, p ≤ 0.01). ILT is effective in improving the inflammatory components of the diet and selected cardiometabolic parameters, including arterial stiffness.
Highlights
Essential hypertension (EH) consists of a pivotal cardiovascular disease (CVD) risk factor, directly associated with a higher incidence of stroke and myocardial infarction, renderingNutrients 2020, 12, 1326; doi:10.3390/nu12051326 www.mdpi.com/journal/nutrientsessential hypertension (EH) a major public health concern [1,2]
Out of 81 patients randomized in total (Figure 1), two from the intensive lifestyle treatment (ILT) group and three from the controls were excluded from the analyses for having extreme energy intake records according to the Goldberg criteria for adequate energy reporting
Reported dietary Na intake did not differ; when dietary Na intake was calculated from the urinary Na excretion, a significant reduction was noted in the ILT compared to the baseline as well as a significantly lower intake as compared to the usual care participants, at the end of the treatment (p ≤ 0.001 for both)
Summary
Essential hypertension (EH) consists of a pivotal cardiovascular disease (CVD) risk factor, directly associated with a higher incidence of stroke and myocardial infarction, renderingNutrients 2020, 12, 1326; doi:10.3390/nu12051326 www.mdpi.com/journal/nutrientsEH a major public health concern [1,2]. Endothelial dysfunction is the hallmark of EH and CVD pathophysiology, preceding atherosclerosis, while contributing significantly to the subclinical target organ damage [3,4]. It reflects the loss of the vasodilating properties of the vascular bed, mainly due to a reduced nitric oxide availability, leading to the expression of a pro-thrombotic, pro-inflammatory and pro-atherosclerotic vasculature phenotype [5]. Micro- and macrovascular dysfunction are both impaired early during the course of EH, entering in a vicious cycle of interaction Inside this loop, sustaining high blood pressure (BP) inevitably leads to hypertension-mediated target organ damage, which in turn aggregates BP [6]
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