11.7 Lifestyle Modifications: a Very Good Weapon Against Hypertension
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High Blood Press Cardiovasc Prev 2008; 15 (3): 171-215 1120-9879/08/0003-0171/$48.00/0 © 2008 Adis Data Information BV. All rights reserved.
Therapy, Pharmacoeconomics and Pharmacovigilance 11.7 Lifestyle Modifications: a Very Good Weapon Against Hypertension A. Di Patria (1), A. Lerro (1), M. Pietrosante (1), V. Del Villano (1) (1)Casa di Cura Villa delle Magnolie, Castel Morrone, Italy Introduction. Although all the international guidelines suggest modifications in lifestyle in association with pharmacological therapy to obtain a better control on blood pressure (BP) and limit organ damage, and though advantage is obtained even in primary prevention, the focus on this field and the application in clinical practice are still poor and appropriate educational programmes are not completely available. Aim. To demonstrate that lifestyle changes have a significant and immediate impact in hypertensive people. Methods. We have studied 500 patients admitted to our Cardiac Rehabilitation Unit (males 72%, age range 45-75 years). All patients had been taking anti-hypertensive drugs for one year at least. 70% had dyslipidaemia, 82% diabetes mellitus, 80% smokers, 54% usual alcohol consumers, 62% overweight, 38% obese, 74% with ischaemic heart disease, 70% not practicing any physical activity, 20% occasional physical activity, 10% regular physical activity. All patients underwent functional evaluation including EKG, trans thoracic echocardiography, carotid arteries and abdominal aorta ultrasound, chest X-ray, 24-hour EKG recording, spirometry, peripheral oxygen saturation, blood samples. BMI and waist circumference were measured. All patients started a psycho-physical training program based on supervised physical activity including callisthenic (4 to 6 Mets, 60 minutes a day) and bike or treadmill exercise (45-60 minutes a day). Psychological interview and psycho-diagnostic tests were performed for every patient. Each patient underwent low calories (1200 Kcal) and low sodium (< 2 gr) diet, individual and group psychotherapy, and an educational program (about healthy dietary habits, obesity, smoke, exercise, stress etc.). Antihypertensive drugs were given (other than aspirin, statins, anti-diabetic drugs etc.). The mean hospitalisation time was 21 days. Results. Multidisciplinary and combined treatment has obtained significant results demonstrating, despite a very short duration, a surprising improvement in BP levels and in cardiovascular risk profile. Mean BP values were 153/87 mmHg at admission (two or more BP lowering drugs taken) and reduced to 137/78 mmHg at discharge (one BP lowering drug taken in 70% patients). Conclusions. Hypertensive patients, if opportunely treated by a supervised psycho-physical training programme including a salt poor/low calorie diet, psychotherapy and health education can have an improved BP profile resulting in a fall of social costs depending on the reduction of pharmacological therapies.
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