Lifestyle Interventions are Effective Treatments of Hypertensive Patients

1
Lifestyle Interventions are Effective Treatments
of Hypertensive Patients
Con

• Thomas Pickering MD, DPhil
• Behavioral Cardiovascular Health and Hypertension
  Program
• Columbia Presbyterian Medical Center
• New York

2
JNC 7 Treatment Overview

• Goals of therapy
• Lifestyle modification
• Pharmacologic treatment
• Algorithm for treatment of hypertension
• Classification and management of BP for adults
• Followup and monitoring

3
JNC 7 Lifestyle Modification
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DASH Fact Sheet
5
Effects of DASH diet on BP

• Study Group BP change Administered
• DASH HT 11.4/5.5 Provided
• BHT 5.5/3.0 Provided
• DASH/Na BHT 8.9/4.5 Provided
• DEW-IT HT 7.4/5.7 Provided
• PREMIER HT 1.7/1.6 Patient
• ALLHAT Diuretic 12.3/8.1

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Effects of DASH diet on BP

• Study Group BP change Administered
• DASH HT 11.4/5.5 Provided
• BHT 5.5/3.0 Provided
• DASH/Na BHT 8.9/4.5 Provided
• DEW-IT HT 7.4/5.7 Provided
• PREMIER HT 1.7/1.6 Patient
• ALLHAT Diuretic 12.3/8.1

7
Lifestyle Modification PREMIER(JAMA 2003 289
2083)
Baseline 3 mo
6 mo
8
Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

9
Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

10
Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

11
Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

12
Failure to Maintain Behavioral Changes over the
Long Term (data of TOHP II)
Months
0
-10
-20
Weight
-30
Na intake
-40
-50
-60
Weight (Kg)
Na intake (mmol/d)
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Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

14
Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

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DASH - How was it done?

• Each weekday, subjects ate lunch or dinner on
  site. After the on-site meal, the subjects
  received coolers containing the food to be
  consumed off site. On Fridays, they also
  received weekend meals, all consumed off-site.

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PREMIER- How was it done?

• Advice only-
• a single 30 minute session

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PREMIER- How was it done?

• Advice only-
• a single 30 minute session

SBP Change -7.8 mmHg
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PREMIER- How was it done?

• Established -
• Goals Weight loss of 15 lbs
• Exercise 3 hours/week
• Restrict Na intake to 100mEq
• Restrict alcohol tolt2 drinks/day
• Procedure Over 6 months of study
• 14 group training sessions
• 4 individual training sessions
• Recorded food and exercise diaries

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PREMIER- How was it done?

• Established -
• Goals Weight loss of 15 lbs
• Exercise 3 hours/week
• Restrict Na intake to 100mEq
• Restrict alcohol tolt2 drinks/day
• Procedure Over 6 months of study
• 14 group training sessions
• 4 individual training sessions
• Recorded food and exercise diaries

SBP Change -12.5 mmHg Incremental change - 4.7
mmHg
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PREMIER- How was it done?

• Established DASH-
• Goals As for Established PLUS
• Increased fruit veg intake
• Decrease total saturated fat
• Increase low-fat dairy
• Procedure Over 6 months of study
• 14 group training sessions
• 4 individual training sessions
• Recorded food and exercise diaries

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PREMIER- How was it done?

• Established DASH-
• Goals As for Established PLUS
• Increased fruit veg intake
• Decrease total saturated fat
• Increase low-fat dairy
• Procedure Over 6 months of study
• 14 group training sessions
• 4 individual training sessions
• Recorded food and exercise diaries

SBP Change -14.2 mmHg Incremental change -
1.7mmHg
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Comparison of Fruit/Vegetable Intake in DASH
PREMIER
Servings per Day
DASH PREMIER
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Issues in the Treatment of Hypertension

• Drugs DASH
• If I do it, will it work? Yes Yes
• Will I do it? Maybe No
• Will I continue to do it? Maybe No
• Will it lower risk ? Yes ?Yes
• Is it cost-effective? Very No

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Lifestyle Interventions are Effective Treatments
of Hypertensive PatientsConclusions

• Lifestyle interventions such as the DASH diet CAN
  produce substantial reductions of BP, and
  probably of risk
• In reality, most patients will NOT achieve
  sufficient changes to have a major impact on BP