Background:Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown.Methods:One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure.Results:Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (–12.5 [95% CI, –14.9 to –10.2] mm Hg) compared with SEPA(–7.1 [–95% CI, 10.4 to –3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (–7.0 [95% CI, –8.5 to –4.0] mm Hg), with no change in SEPA (–0.3 [95% CI, –4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus –1.1 ms/mm Hg [95% CI, –2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms² [95% CI, 0.2 to 0.6] versus –0.2 ln ms² [95% CI, –0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, –0.3 to 1.0] versus –1.4% [95% CI, –2.5 to –0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596).Conclusions:Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808.

中文翻译：

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生活方式改变对顽固性高血压患者的影响：TRIUMPH 随机临床试验的结果

背景：虽然生活方式的改变通常可有效降低非药物治疗高血压患者和接受 1 或 2 种抗高血压药物治疗的患者的血压（BP），但运动和饮食对降低顽固性高血压患者血压的价值尚不清楚。方法： 140 名顽固性高血压患者（平均年龄 63 岁；48% 女性；59% 黑人；31% 患有糖尿病；21% 患有慢性肾病）被随机分配到为期 4 个月的生活方式改变计划（C-LIFE [基于中心的生活方式干预]）包括饮食咨询、行为体重管理和锻炼，或提供 SEPA（标准化教育和医师建议）的单次咨询会议。主要终点是临床收缩压；P = 0.005); C-LIFE 的 24 小时动态收缩压也降低（–7.0 [95% CI，–8.5 至 –4.0] mm Hg），而 SEPA 没有变化（–0.3 [95% CI，–4.0 至 3.4] mm汞）（P = 0.001）。与 SEPA 相比，C-LIFE 在静息压力反射灵敏度方面有更大的改善（2.3 ms/mm Hg [95% CI，1.3 至 3.3] 与 –1.1 ms/mm Hg [95% CI，–2.5 至 0.3]；P < 0.001）、高频心率变异性（0.4 ln ms ² [95% CI，0.2 至 0.6] 对比 –0.2 ln ms ² [95% CI，–0.5 至 0.1]；P <0.001）和血流介导的扩张（0.3% [95% CI，–0.3 至 1.0] 与 –1.4% [95% CI，–2.5 至 –0.3]；P = 0.022）。脉搏波速度无组间差异（P=0.958）或左心室质量（P =0.596）。结论：饮食和运动可以降低顽固性高血压患者的血压。在心脏康复环境中实施的为期 4 个月的结构化饮食和锻炼计划作为辅助治疗可显着降低临床和动态血压，并改善选定的心血管疾病生物标志物。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02342808。