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Lifestyle modification may help patients with resistant hypertension: Results of the TRIUMPH randomized clinical trial

It is well-known that lifestyle modification is generally effective in lowering blood pressure (BP) among patients with non-severe hypertension, and current guidelines propose lifestyle interventions before start of antihypertensive medications in lower-risk patients. However, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown.
The TRIUMPH trial, published in the October issue of Circulation, enrollled140 participants with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease). The patients were randomly assigned to a 4-month program of lifestyle modification including dietary counseling, behavioral weight management, and exercise, or a single counseling session in addition to standard care. The study intervention included instruction from a nutritionist on how to follow the DASH diet, as well as restricting calories and sodium to less than 2,300 mg/day. Further, it included weekly, 45-minute group counseling sessions, run by a clinical psychiatrist, focusing on eating behaviors. The exercise component included 30- to 45-minute sessions at 70%-85% of initial heart rate reserve, carried out three times per week at a cardiac rehabilitation facility. The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity, high-frequency heart rate variability, flow-mediated dilation, etc.
Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (–12.5 [95% CI, –14.9 to –10.2] mm Hg) compared with SEPA(–7.1 [–95% CI, 10.4 to –3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (–7.0 [95% CI, –8.5 to –4.0] mm Hg), with no change in SEPA (–0.3 [95% CI, –4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus –1.1 ms/mm Hg [95% CI, –2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus –0.2 ln ms2 [95% CI, –0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, –0.3 to 1.0] versus –1.4% [95% CI, –2.5 to –0.3]; P=0.022). 
A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers.

Reference: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055329

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