Behavioral Treatment of High Blood Pressure

描述（由申请人提供）：高血压（HBP）是美国的一个主要健康问题，大多数35岁以上的成年人表现出高于最佳水平的BP。HBP患者表现出亚临床血管疾病，这与心血管和脑血管发病率和死亡率的风险增加有关。虽然药物治疗已被证明在许多患者中成功降低HBP，但药物治疗并不总是成功的，并且可能与医源性影响有关，这些影响依从性并损害生活质量。此外，与HBP相关的异常，包括胰岛素抵抗和血脂异常，可能持续存在，甚至可能因抗高血压药物而加重。因此，仍然需要开发用于降低HBP的行为治疗。现在有充分的理由相信饮食和锻炼可能是这样的方法之一。本申请中提出的研究将建立在我们以前的工作基础上，我们在以前的工作中证明了运动，特别是当与行为减肥计划相结合时，会导致临床上显着的BP降低。此外，喂养研究表明，高低脂乳制品以及水果和蔬菜（即，DASH饮食）可以显著降低BP而不减轻体重。本申请试图通过以下方式扩展这些发现：（a）评估DASH饮食在自由生活情况下的功效;（B）考虑单独的DASH饮食以及与包括有氧运动的认知行为减肥计划的组合;（c）检查饮食和运动对心脏、代谢和血管功能的影响，和（d）随访患者一年，以确定干预对BP、体重和心血管功能的长期影响。120名患有HBP的男性和女性将被随机分配到单独的DASH饮食，DASH饮食与行为减肥计划相结合，或常规护理控制条件。在治疗4个月之前和之后，患者将接受BP评估和动脉硬度、内皮功能、压力反射控制、身体组成、胰岛素抵抗、全身血液动力学以及左心室结构和功能的测量。 12个月随访将评估获益的维持情况。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，单独和结合热量限制和运动，可以降低血压和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.