Supervised Lifestyle Modifications Deliver Powerful Results in Resistant Hypertension: TRIUMPH Trial

High blood pressure, a silent threat lurking in the shadows, affects millions worldwide. For some, even the combined might of three or moremedications fails to keep it at bay, leading to the formidable foe known as resistant hypertension (RH). But a new study, theTRIUMPH trial, published by the American Heart Association, sheds light on a powerful weapon in the fight against RH: supervised lifestyle modifications.

Key points

Background: Resistant hypertension (RH), defined as uncontrolled blood pressure (BP) despite ≥3 antihypertensive medications, affects ∼5% of the global population and carries significantly elevated cardiovascular risk. While lifestyle modifications are established interventions for hypertension, their efficacy in RH remains less clear.

Objective: The TRIUMPH trial aimed to evaluate the impact of an intensive, supervised lifestyle modification program on BP control and cardiovascular health in individuals with RH.

Methods: The randomized, controlled trial enrolled 140 adults with RH (mean age 63 years, 48% female, 59% black) with diverse comorbidities. Participants were randomly assigned to either:

• Supervised Intervention: Three times per week, participants engaged in an intensive cardiac rehabilitation program encompassing dietary counseling, aerobic exercise training, and weight management guidance within a supervised setting.

• Self-Guided Intervention: Participants received a single educational session on lifestyle modifications and written guidelines for independent implementation.

The primary outcome was a change in clinic systolic BP after 4 months. Secondary outcomes included ambulatory BP monitoring, lipid profiles, fitness level, and other cardiovascular health markers.

Results: Compared to the self-guided group (-7 mmHg), the supervised intervention group demonstrated a significantly greater reduction in clinic systolic BP (-12 mmHg; p<0.001). This difference remained evident in ambulatory BP monitoring. Additionally, the supervised group exhibited significant improvements in cholesterol levels, body weight, fitness level, and other cardiovascular health indicators compared to the self-guided group.

Conclusions: This first-of-its-kind study provides compelling evidence that an intensive, supervised lifestyle modification program conducted in a cardiac rehabilitation setting effectively lowers BP and improves cardiovascular health in individuals with RH. These findings suggest that comprehensive lifestyle interventions, in conjunction with existing medication regimens, could play a crucial role in optimizing RH management and reducing cardiovascular risk in this high-risk population.

Future Directions: Further research is warranted to investigate the long-term sustainability of these benefits and to optimize program implementation for broader access and scalability. Overall, the TRIUMPH trial strengthens the scientific rationale for incorporating supervised lifestyle modifications as a valuable adjunct therapy for patients with RH.

Resistant hypertension (RH), characterized by uncontrolled blood pressure (BP) despite ≥3 antihypertensive medications, affects ∼5% of the global population and carries significantly elevated cardiovascular risk. While lifestyle modifications are established non-pharmacological interventions for hypertension, their efficacy in RH remains less clear.

Objective: The TRIUMPH trial aimed to evaluate the impact of an intensive, supervised lifestyle modification program on BP control and cardiovascular health in individuals with RH.

Methods: The randomized, controlled trial enrolled 140 adults with RH (mean age 63 years, 48% female, 59% black) with diverse comorbidities. Participants were randomly assigned to either:

• Supervised Intervention: Three times per week, participants engaged in an intensive cardiac rehabilitation program encompassing dietary counselling, aerobic exercise training, and weight management guidance within a supervised setting. This intervention followed the principles of the DASH (Dietary Approaches to Stop Hypertension) diet and American Heart Association nutrition recommendations.

• Self-Guided Intervention: Participants received a single educational session on lifestyle modifications and written guidelines for independent implementation.

The primary outcome was a change in clinic systolic BP after 4 months. Secondary outcomes included ambulatory BP monitoring, lipid profiles, fitness level, and other cardiovascular health markers.

Results: Compared to the self-guided group (-7 mmHg), the supervised intervention group demonstrated a significantly greater reduction in clinic systolic BP (-12 mmHg; p<0.001). This difference remained evident in ambulatory BP monitoring. Additionally, the supervised group exhibited significant improvements in cholesterol levels, body weight, fitness level, and other cardiovascular health indicators compared to the self-guided group. This first-of-its-kind study provides compelling evidence that an intensive, supervised lifestyle modification program conducted in a cardiac rehabilitation setting, focusing on the DASH diet and American Heart Association guidelines, effectively lowers BP and improves cardiovascular health in individuals with RH. These findings suggest that comprehensive lifestyle interventions, in conjunction with existing medication regimens, could play a crucial role in optimizing RH management and reducing cardiovascular risk in this high-risk population.

Significant Systolic BP Reduction: The TRIUMPH trial demonstrated a substantial difference in systolic blood pressure (SBP) reduction between the supervised and self-guided intervention groups. Participants in the supervised program experienced a significantly greater mean reduction in clinic SBP (-12 mmHg) compared to the self-guided group (-7 mmHg)—a statistically significant difference (p < 0.001). This finding aligns with previous research suggesting the potential efficacy of intensive lifestyle modifications in RH management.

Ambulatory BP Monitoring Corroborates Findings: Notably, the 24-hour ambulatory BP monitoring data further validates the observed benefits of supervised lifestyle modifications. The supervised group exhibited a clinically meaningful 7-point reduction in ambulatory SBP, whereas the self-guided group showed no change. This consistency across measurement methods strengthens the evidence for the program's effectiveness in lowering BP beyond clinical settings.

Improved Cardiovascular Health Markers: Beyond BP reduction, the supervised group demonstrated significant improvements in other cardiovascular health indicators, including lipid profiles, body weight, and fitness level. These findings suggest a broader positive impact on the participants' overall cardiovascular risk profile, potentially reducing their long-term risk of adverse events.

Blumenthal's Commentary: Dr. Blumenthal, the lead author, highlights the significance of these findings by emphasizing the potential for successful weight loss and increased physical activity in RH patients through supervised lifestyle modifications. He acknowledges the individual variability in lifestyle change feasibility and underscores the potential for dose adjustments or medication alterations for patients in consultation with their physicians.

Study Limitations and Generalizability: The single-institution design of the study raises concerns about the generalizability of the findings to broader populations. However, the program's implementation in diverse cardiac rehabilitation centres in central North Carolina with varied educational and cultural backgrounds adds to its potential real-world applicability. Future research with larger, geographically diverse samples is warranted to fully assess the program's generalizability.

Sustainability of Lifestyle Changes: The study's duration (4 months) limits our understanding of the long-term sustainability of observed lifestyle changes and their lasting impact on BP control. Future research should investigate strategies to promote long-term adherence and maintenance of healthy habits in this population.

Clinical Implications: Dr. Gibbs, an expert in lifestyle interventions for hypertension, emphasizes the value of this research for clinicians managing RH patients. She reiterates the importance of combining lifestyle modifications with existing medications for optimal BP control and highlights the feasibility of implementing supervised programs within existing cardiac rehabilitation frameworks.

Key Takeaway: The TRIUMPH trial provides compelling evidence for the efficacy of intensive, supervised lifestyle modifications in lowering BP and improving cardiovascular health in individuals with RH. These findings encourage the integration of such programs into comprehensive management strategies for RH patients, alongside optimal pharmacotherapy, potentially leading to improved clinical outcomes and a reduction in cardiovascular risk.

Reference Article

Healthy changes in diet, activity improved treatment-resistant high blood pressure. (n.d.). American Heart Association. https://newsroom.heart.org/news/healthy-changes-in-diet-activity-improved-treatment-resistant-high-blood-pressure#:~:text=Researchers%20found%20that%20behavioral%20changes%2C%20including%20regular%20aerobic,improve%20cardiovascular%20health%20in%20people%20with%20resistant%20hypertension

Related Articles:

Best Dietary Advice for Lowering Blood Pressure | Healthnewstrend

Latest Hypertension Research: What You Need to Know | Healthnewstrend

Night-time Blood Pressure Assessment for Hypertension Diagnosis: Why It's Important | Healthnewstrend

https://healthnewstrend.com/nuts-and-seeds-a-comprehensive-review-of-their-health-benefits

Medical Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.