Impact of Dietary Patterns on the Lipidemic Profile and the Cardiovascular Risk in Stage 1 Hypertension: A Post Hoc Analysis of the HINTreat Trial

Abstract

Background/Objectives: In hypertension (HTN), lifestyle modification is important for controlling blood pressure (BP) and lipidemic profile. The HINTreat trial showed that an anti-inflammatory diet was associated with improved endothelial function, after six months of intensive nutritional treatment. Methods: This post hoc analysis of the HINTreat trial examined how adherence to various nutritional patterns like the Mediterranean Diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH) diet, and anti-inflammatory diet, had impact on the blood lipids profile and the CVD risk. Patients with stage 1 HTN, allocated either on intensive lifestyle treatment (ILT) or usual care (UC) standard treatment, participated in the analysis. From the original sample size of the HINTreat trial, all patients that were prescribed lipid lowering medication at any time of the study period were excluded from the total analysis; thus, the intervention and the control groups consisted of 33 and 28 patients, respectively. Nutritional intakes were assessed with repeated 24 h recalls from the previous day, and dietary indexes and scores were calculated as follows: MedDiet score, DASH index, and Dietary Inflammatory Index (DII). After six months of intervention, changes in the nutritional indexes and their effect on the lipidemic profile and CVD risk were analyzed. Results: In the ILT group, reductions were noted in Ambulatory Blood Pressure Monitoring (ABPM) for day systolic BP (SBP) (-12.7 mmHg) and diastolic BP (DBP) (-8.4 mmHg), total cholesterol (TC) (-35.4 mg/dL), triglycerides (TG) (-21.4 mg/dL), LDL cholesterol (LDL-C) (-27.5 mg/dL) concentrations, and CVD risk score (-1.5%), p < 0.001 for all. Multiple regression analysis showed that dietary quality indices independently influenced improvements in blood lipid profile and cardiovascular disease (CVD) risk among patients receiving ILT. Specifically, a higher Mediterranean Diet (MedDiet) score was significantly associated with reductions in TC (B = -7.238, p < 0.001), TG (B = -4.103, p = 0.035), and LDL-C (B = -6.431, p = 0.004). The DASH index was positively associated with TG levels (B = 9.913, p = 0.010), suggesting a more complex relationship that may require further investigation. In addition, DII was positively associated with increased CVD risk (B = 0.973, p < 0.001). Conclusions: The findings suggest that ILT can improve BP levels, target blood lipids concentrations, and reduce CVD risk in patients with stage 1 HTN.

Keywords: DASH diet; Mediterranean Diet; diet; dietary inflammatory index; dietitian; hypercholesterolemia; lifestyle intervention; medical nutrition therapy; nutrition.

Figure 1

Blood lipid levels for both groups at baseline and at the end of six months lifestyle treatment. HDL: High-density Lipoprotein (D); ILT: Intensive Lifestyle Treatment; LDL-C: Low Density Lipoprotein Cholesterol (B); ns: non-significant; TC: Total Cholesterol (A); TG: Triglycerides (C); UC: Usual Care; μ: Mean; * Statistically different compared to baseline measurements (**** p < 0.0001, *** p = 0.0001 to 0.001, ** p = 0.001 to 0.01, * p = 0.01 to 0.05, ns: p = ≥0.05).

Figure 2

HRS for CVD changes for both groups at baseline and at the end of six months lifestyle treatment. CVD: Cardiovascular Disease; HRS: Hellenic Risk Score; ILT: Intensive Lifestyle Treatment; ns: non-significant; UC: Usual Care; μ: Mean; * Statistically different compared to baseline measurements (**** p < 0.0001, ns: p = ≥0.05).

Figure 3

Scoring variation in nutritional indexes for both groups from baseline to 6 months lifestyle treatment; DASH: Dietary Approaches to Stop Hypertension Index (B); DII: Dietary Inflammatory Index (C); ILT: Intensive Lifestyle Treatment; MedDiet: Mediterranean Diet Index (A); ns: non-significant; UC: Usual Care; * Statistically different compared to baseline measurements (**** p < 0.0001, ** p = 0.001 to 0.01, * p = 0.01 to 0.05, ns: p = ≥0.05).