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岁以下的成年人血压高于最佳水平。患有高血压的人表现为亚临床血管疾病，这与心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降低许多患者的血压方面是成功的，但药物治疗并不总是成功的，并且可能与损害依从性和降低生活质量的医源性效应有关。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，甚至可能因降压药而加重。因此，仍然需要开发降低HBP的行为治疗方法。现在有充分的理由相信饮食和运动可能是这样一种方法。本申请中提出的研究将建立在我们之前的工作基础上，我们证明了运动，特别是与行为减肥计划相结合，会导致临床上显著的血压降低。此外，饲养研究表明，低脂乳制品以及水果和蔬菜含量高的饮食（即DASH饮食）可以显著降低血压，而不会减轻体重。本应用程序旨在通过(a)评估DASH饮食在自由生活情况下的功效来扩展这些发现；(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，(d)对患者进行为期一年的随访，以确定干预对血压、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单独的DASH饮食，DASH饮食与行为减肥计划相结合，或通常的护理控制条件。在治疗前后4个月，患者将接受血压和动脉僵硬度、内皮功能、压力反射控制、身体成分、胰岛素抵抗、全身血流动力学和左心室结构和功能的评估。12个月的随访将评估获益的维持情况。本研究产生的数据将具有重要的临床意义，可以确定DASH饮食单独或结合热量限制和运动在多大程度上降低血压并改善相关危险因素。

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.