Lifestyle Interventions Reduce the Need for Guideline-Directed Antihypertensive Medication

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00571844.

Keywords: DASH diet; antihypertensive drugs; blood pressure; hypertension; lifestyle modification.

© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Figures

Graphical Abstract

Figure 1.

Treatment-related changes in CVD risk, including the 10-year risk of CVD (a), the lifetime risk of CVD (b), and risk of lifetime CVD death (c). The upper and lower borders of the boxes represent the upper and lower quartiles, respectively, and the lines within the boxes represent medians. Abbreviations: CVD, cardiovascular disease; DASH, DASH diet; DASH + WM, DASH diet and weight management.

Figure 2.

Percentages of participants in the 3 treatment arms with an indication for antihypertensive therapy at baseline and at the completion of the intervention. Abbreviations: DASH, DASH diet; DASH + WM, DASH diet and weight management.