Healthy lifestyle helps hard-to-treat hypertensive patients

By Eleanor McDermid, Senior medwireNews Reporter

Maintaining a healthy lifestyle can prevent cardiovascular events even among patients with apparent treatment-resistant hypertension, say researchers.

Undertaking physical activity and not smoking were the two factors with the largest impact, report Keith Diaz (Columbia University Medical Center, New York, USA) and team.

They say that the effect of lifestyle factors is little studied in patients with treatment-resistant hypertension, for whom invasive, irreversible approaches such as renal denervation have been developed. But the team stresses that “it is important to determine the efficacy of less invasive approaches to spare individuals the inconvenience and possible complications that come from these procedures.”

The data come from an analysis of 2043 participants of the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. These people had blood pressure of 140/90 mmHg or more, despite treatment with at least three classes of antihypertensive drug, or required at least four classes of antihypertensive drug to control their blood pressure.

During an average 4.5 years of follow-up, these study participants had 360 cardiovascular events. Of the six healthy lifestyle factors assessed, only two – physical activity and not smoking – were individually associated with cardiovascular outcomes after accounting for confounders including age, race, cholesterol profile, renal disease and diabetes. Specifically, not smoking was associated with a 46% risk reduction and undertaking physical activity at least four times a week conferred a 33% risk reduction relative to not doing any exercise.

The other four lifestyle factors – absence of abdominal obesity, moderate or no alcohol consumption, a healthy diet (high Dietary Approaches to Stop Hypertension diet score) and low ratio of sodium to potassium intake – were not individually associated with cardiovascular outcomes.

However, there was a significant association between a higher number of healthy lifestyle factors and a lower risk of cardiovascular events, with participants who had four to six factors a significant 37% less likely to have a cardiovascular event then those with no or one factor. There was a similar association for all-cause mortality.

This suggests that there may be “incremental benefits to increasing the number of healthy lifestyle factors” in people with treatment-resistant hypertension, write the researchers in Hypertension.

The potential for improving patients’ cardiovascular risk is therefore large, they note, given that only 13.7% of the study population reported at least four of the six healthy lifestyle factors under study.

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