Hypocaloric diet and antihypertensive drug treatment. A randomized controlled clinical trial.
OBJECTIVE
To compare the amount of drug quantified by a score needed to control blood pressure in two groups of overweight hypertensive patients, receiving or not receiving a hypocaloric diet.


METHODS
Randomized controlled clinical trial.


METHODS
Two hospital outpatient hypertension clinics.


METHODS
Fifty-four subjects with a DBP between 95 and 110 mmHg and a weight > or = 110% of the ideal weight.


METHODS
Allocation to either drug treatment (DT) or hypocaloric diet (HD). In the HD group, after 2 months, an antihypertensive drug was administered to the subjects with a DBP > or = 90 mmHg, following the same scheme protocol as in the DT group. Subjects were followed during 10 months by a clinician only in the DT group and by a clinician and a dietician in the HD group.


METHODS
Score of treatment: hydrochlorothiazide 25 mg [score = 1] with, as needed to obtain a DBP < 90 mmHg, the addiction of enalapril 10 mg [score = 2], 20 mg [score = 3], and nifedipine 40 mg [score = 4].


RESULTS
At the end of the trial, 5 subjects were lost to follow-up in the HD group and 1 in the DT group (p > 0.05). Mean weight loss was 5.9 kg (sd = 1.2) in the HD and 2.3 kg (sd = 0.7) in the DT group (p = 0.02). Mean decrease in DBP was 18 mmHg (sd = 7) and 15 mmHg (sd = 8) in HD and DT groups respectively (p = 0.36). Mean DBP was 84 mmHg (sd = 7.8) in the HD group and 85 mmHg (sd = 7.2) in the DT group. In the HD group, 8 (38.1%) subjects had a DBP < 90 mmHg without any drug treatment. The mean drug treatment score was 0.86 (sd = 0.91) in the HD and 1.52 (0.70) in the DT group (p = 0.01).


CONCLUSIONS
This study shows that in overweight hypertensives, the quantity of drug needed to achieve an acceptable level of BP is nearly reduced by 50% when an efficient hypocaloric diet is prescribed simultaneously.
Darné
B
B
INSERM U258, Epidemiologie cardio-vasculaire, Hôpital Broussais, Paris, France.
Nivarong
M
M
Tugayé
A
A
Safar
M
M
Plouin
P F
PF
Guillanneuf
M T
MT
Cubeau
J
J
Pannier
B
B
Péquignot
F
F
Cambien
F
F
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy
D000959:Antihypertensive Agents