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. 2018 Jul;48(7):637-651.
doi: 10.4070/kcj.2017.0349.

The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial

Chan Joo Lee #  1 , Ji Young Kim #  2   3   4 , Eugene Shim  5 , Sung Hyun Hong  2   3 , MiKyung Lee  2   3   4 , Justin Y Jeon  2   3   6 , Sungha Park  7   8
Affiliations

The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial

Chan Joo Lee et al. Korean Circ J. 2018 Jul.

Abstract

Background and objectives: Supervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management.

Methods: Eighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909).

Results: Seventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (-5.2 mmHg; 95% CI, -8.3 to -2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, -2.5 to 3.3).

Conclusions: In conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.

Keywords: Diet; Exercise; Hypertension; Lifestyle; Prehypertension.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1
Participant flow chart of the Korean LifeStyle Modification on Hypertension study. C group = advice-only comparison group; CPX = cardiopulmonary exercise test; D group = diet education group; D+Ex group = diet and exercise education group; DASH = Dietary Approaches to Stop Hypertension; ITT = intention-to-treat.
Figure 2
Figure 2
Comparison of post-intervention means and 95% CI for office BP and daytime ambulatory BP using an ANCOVA model adjusted for age, sex, and pre-intervention BP. (A) The left panels show the differences between both intervention groups and the control group were insignificant for office SBP (p=0.347) and DBP (p=0.801). The right panels show the comparison of mean differences and 95% CI between the intervention groups using an ANCOVA model adjusted for age, sex, and pre-intervention office SBP. (B) The left panels show the difference between both intervention groups and the control group was significant for daytime ambulatory SBP (p=0.034) and insignificant for daytime ambulatory DBP (p=0.097). The right panels show the comparison of mean differences and 95% CI between the intervention groups using an ANCOVA model adjusted for age, sex, and pre-intervention daytime ambulatory SBP. ANCOVA = analysis of covariance; BP = blood pressure; C group = advice-only comparison group; CI = confidence interval; DBP = diastolic blood pressure; D group = diet education group; D+Ex group = diet and exercise education group; ITT = intention-to-treat; SBP = systolic blood pressure.
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