Usefulness of ambulatory blood pressure monitoring in detecting the additional antihypertensive effect of non-pharmacologic treatment.
OBJECTIVE: The present study was designed to investigate whether a non-pharmacologic intervention program (NPIP) consisting of a weight-lowering diet, a reduction in alcohol consumption and physical training at 50% peak aerobic capacity could enhance the blood-pressure-lowering effect of calcium antagonists in obese sedentary, hypertensive patients. METHODS: Fifty-nine subjects were treatred with 5-10 mg isradipine once daily for 8 weeks and were then randomly allocated to either isradipine monotherapy or isradipine plus NPIP for 20 weeks. Clinic and ambulatory blood pressure were used for assessing the antihypertensive effect obtained in both treatment groups. RESULTS: Clinic and ambulatory systolic and diastolic blood pressures decreased significantly after 8 weeks of isradipine monotherapy. At week 28, the group treated with isradipine combined with NPIP and in which significant modifications in body weight (P < 0.0001), alcohol intake (P < 0.0001) and peak oxygen uptake (P <0.01) were observed, had significant (P < 0.05) additional decrements in ambulatory but not clinic blood pressure. CONCLUSIONS: These results demonstrate that the addition of lifestyle modifications in obese sedentary hypertensive patients already receiving pharmacological therapy can induce further blood pressure decrements. Because significant decrements were noticed only with ambulatory blood pressure monitoring, the results of the present study advocate this technique for assessing the magnitude of blood pressure reduction with non-pharmacological therapy.
Poirier
L
Hypertension Research Unit, Le Centre Hospitalier de l'Université Laval Research Center, Sainte-Foy, Québec, Canada.
Cléroux
J
Lefebvre
J
Yardley
C
Lacourcière
Y