Impact of Lifestyle Medicine Interventions on the Management of Systemic Hypertension in Primary Care: A Canadian Randomized Controlled Trial

Abstract

The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T₀ and T₆, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T₆. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension.

Keywords: hypertension; lifestyle medicine; medication; primary care.

Figure 1.

Study design and intervention details. Note: ¹Questionnaires were Educoeur-en-route-77Q; physical activity assessment (3-day physical record); dietary assessment (3-day dietary record, Nutrition habit-27Q; Three-factor eating questionnaire-51Q (TFEQ), Beck Anxiety Inventory-21Q (BDI), State-trait Anxiety Inventory-20Q (STAI), SF-36-Q11 (quality of life); Food Frequency Questionnaire. Abbreviations: ²CT, computed tomography; ³TET, treadmill exercise test; ⁴DASH, Dietary Approaches to Stop Hypertension. ⁵Lifestyle intervention: all participants were meeting with a kinesiologist and/or a registered dietitian for 7 visits over 6 months, that is, 2 visits in the first month following by monthly visits for the 5 other months.

Figure 2.

Flowchart of participants.

Figure 3.

Changes in systolic and diastolic blood pressure pre- and post-intervention in each intervention group. Note: Values are presented as mean ± SD. SBP and DBP are overall 24-h ambulatory blood pressure monitoring mean. Statistical differences are presented as *when P ≤ .05 and as **when P < .01. Abbreviations: MED, standard medical care intervention group; PA, physical activity intervention group; NUT, nutrition intervention group (DASH diet); COMBI, combination of physical activity and nutrition interventions group.

Figure 4.

Changes in systolic and diastolic blood pressure pre- and post-intervention in non-medicated and medicated participants. Note: Statistical differences are presented as *when P ≤ .05 and as **when P < .01.