Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial

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.

Effect of a 6-Month Controlled Lifestyle Intervention on Common Carotid Intima-Media Thickness

“…The majority of controlled lifestyle (including diet and/or exercise) interventions have failed to demonstrate a clear effect on ccIMT compared to control (24,49), while only one of these unsuccessful studies reported a subgroup analysis with highrisk participants (50). However, some controlled trials using diet and/or exercise have been able to show a favourable effect on ccIMT (decrease or slowed progression), and when dietary recommendations were given, these included advice to adhere to a traditional Mediterranean diet (which is a plant-based dietary pattern) (51,52) or to consume less salt and alcohol and more fruit and vegetables (53), and in one study, more dairy (20) (all randomized controlled trials).…”

Gut microbiota, dysbiosis and atrial fibrillation. Arrhythmogenic mechanisms and potential clinical implications

“…1 Clinical and preclinical observations suggest that a large number of concomitant modifiable cardiovascular risk factors determine the manifestation and progression of AF. 2 Interestingly, most AF risk factors such as coronary artery disease, 3 heart failure, 4 hypertension, 5 diabetes, and obesity 6 are linked to dietary intake and lifestyle components.…”

Healthy lifestyle changes favourably affect common carotid intima-media thickness: the Healthy Lifestyle Community Programme (cohort 2)

“…To date, only a small number of controlled trials have assessed the effect of a combined lifestyle intervention (including diet and other lifestyle factors) on ccIMT (22,(24)(25)(26)(27)(28) , and only two of these trials were conducted with generally healthy participants (27,28) : in a suburban population in Japan, Okada et al observed no significant effect of a 2-year lifestyle modification on mean ccIMT change (compared to control; dietary recommendations were based on the goals of the National Cholesterol Education Program; <30 % total fat, <7 % saturated fat and <200 mg dietary cholesterol per day) (27) . Similarly, in a study with perimenopausal women in the United States, Wildman et al observed no significant effect of a 4-year diet (≤25 % total fat, ≤7 % saturated fat, ≤100 mg dietary cholesterol and 1300 kcal/d) and exercise intervention on mean ccIMT change (compared to control) (28) .…”