Behavioral Treatment of High Blood Pressure

描述(由申请人提供)：高血压(HBP)在美国是一个主要的健康问题，大多数35岁的成年人表现出高于最佳水平的血压。高血压患者表现出亚临床血管疾病，这与心脑血管发病率和死亡率的增加有关。虽然药物治疗已被证明在降低许多患者的HBP方面是成功的，但药物治疗并不总是成功的，可能与医源性效应有关，这些效应损害了依从性并损害了生活质量。此外，与高血压相关的异常，包括胰岛素抵抗和血脂异常，可能会持续存在，甚至可能因抗高血压药物而加剧。因此，仍有必要开发降低HBP的行为疗法。现在有充分的理由相信，节食和锻炼可能就是这样一种方法。本申请中提出的研究将建立在我们之前工作的基础上，在我们之前的工作中，我们证明了锻炼，特别是当与行为减肥计划相结合时，导致了临床上显著的血压下降。此外，喂养研究表明，在不减轻体重的情况下，高摄入低脂乳制品以及水果和蔬菜(即DASH饮食)可能会显著降低血压。本申请旨在通过以下方式扩大这些发现：(A)评估DASH饮食在自由生活情况下的有效性；(B)单独考虑DASH饮食并结合包括有氧运动在内的认知行为减肥计划；(C)检查饮食和运动对心脏、代谢和血管功能的影响；以及(D)对患者进行一年的跟踪，以确定干预措施对血压、体重和心血管功能的长期影响。120名患有高血压的男性和女性将被随机分配到仅接受DASH饮食、结合行为减肥计划的DASH饮食或常规护理控制条件下。在治疗前和治疗4个月后，患者将接受血压评估以及动脉僵硬、内皮功能、压力反射控制、身体成分、胰岛素抵抗、全身血流动力学以及左心室结构和功能的测量。12个月的随访将评估福利的维持情况。这项研究产生的数据将具有重要的临床意义，通过确定DASH饮食单独以及与卡路里限制和锻炼相结合可能降低血压并改善相关风险因素的程度。

DESCRIPTION (provided by applicant): High Blood Pressure (HBP) is a major health problem in the United States, with most adults >35 years of age exhibiting BP above optimal levels. Persons with HBP exhibit subclinical vascular disease, which is associated with increased risk for cardiovascular and cerebrovascular morbidity and mortality. Although pharmacologic treatments have proven to be successful in reducing HBP in many patients, drug therapy is not always successful and may be associated with iatrogenic effects that compromise compliance and impair quality of life. Furthermore, abnormalities associated with HBP, including insulin resistance and dyslipidemia, may persist or may even be exacerbated by anti-hypertensive medications. Thus, there continues to be a need to develop behavioral treatments for reducing HBP. There is now good reason to believe that diet and exercise may be one such approach. The study proposed in this application will build upon our previous work in which we demonstrated that exercise, especially when combined with a behavioral weight loss program, resulted in clinically significant BP reductions. In addition, feeding studies have demonstrated that a diet high in low fat dairy products as well as fruits and vegetables (i.e., the DASH diet) may significantly reduce BP without weight loss. The present application seeks to extend these findings by (a) evaluating the efficacy of the DASH diet in a free-living situation; (b) considering the DASH diet alone and in combination with a cognitive-behavioral weight loss program including aerobic exercise; (c) examining the impact of diet and exercise on cardiac, metabolic, and vascular function, and (d) following patients for one year to determine the longer term impact of the interventions on BP, body weight, and cardiovascular function. One hundred twenty men and women with HBP will be randomly assigned to the DASH diet alone, the DASH diet combined with a behavioral weight loss program, or to a usual care control condition. Before and after 4 months of treatment, patients will undergo assessments of BP and measures of arterial stiffness, endothelial function, baroreflex control, body composition, insulin resistance, systemic hemodynamics, and left ventricular structure and function. Twelve month follow-up will assess maintenance of benefit. The data generated from this study will have important clinical significance by determining the extent to which the DASH diet, alone and combined with caloric restriction and exercise, may lower BP and improve associated risk factors.