Prospective Study Of Therapeutic Lifestyle Intervention In Hypertensive Patients Combined With Early Atherosclerotic Changes

Background:Rapid development of China’s economy resulted in the substantial changes in theway people ate and lived. Dietary and lifestyle modifications have shown promise inenhancing the effectiveness of blood pressure management. Hypertension is the mostcommon cardiovascular risk factor in the Chinese. Risk factors in patients withhypertension are gathered (multiple other cardiovascular disease risk factors inpatients with hypertension coexisting), which would further increase the totalcardiovascular risk in patients with hypertension. It also increases the complexity anddifficulty of hypertension treatment down. Vascular disease is a commonpathophysiological basis of hypertension and other cardio-cerebral vascular disease.Atherosclerosis and arteriosclerosis (refers to the vascular structure and function) arethe typical characteristic of early vascular disease, and vascular function changesearlier than structure changing. It has been well established that early detection ofvascular disease are important for prevention of cardio-cerebral vascular events.Lifestyle interventions have been shown to ameliorate or prevent the progression ofindividual components of hypertension and other cardio-cerebral vascular disease.The aim of the present study, was to determine the vascular function by subclinicaldetection indicators, for example24hours ambulatory blood pressure monitoring,central aortic pressure, carotid-radial pulse wave velocity. Furthermore, we examinethe relationships among lifestyle interventions, blood pressure, arterial geometry andwall stress, and to determine the impact of hypertensive patients combined with arteriosclerosis, lifestyle interventions, subclinical detection indicators, and theirinteraction on these relationships.Objective:1. To observe the relationship of the detection of blood pressure and arteriosclerosisindex with the various risk factors in hypertensive patients combined with earlyatherosclerotic changes.2. To observe the2groups’ changes of24h ABPM after therapeutic lifestyleintervention, blood pressure falling (BPF) and Ambulatory arterial stiffness index(AASI) after therapeutic lifestyle intervention.3. To explore the2groups’ alter of central aortic pressure and parameters aftertherapeutic lifestyle intervention.4. To explore the2groups’ alter of crPWV after therapeutic lifestyle intervention.5. To observe the2groups’ affect on knowledge, attitude and practice (KAP) aftertherapeutic lifestyle intervention.6. To investigate the2groups’ effect on the new complications of heart， head，kidney and cardiovascular outcomes about therapeutic lifestyle intervention.Methods:There were280essential hypertension combined with early atheroscleroticchanges and cardiovascular risk factors recruited, they were randomized into twogroups, and namely, lifestyle intervention group (intervention group)150cases,control group130cases, age and gender were matched in two groups. All the subjectswere received antihypertensive drug therapy, and followed up15months. Therapeuticlifestyle intervention group had mandatory lifestyle intervention (low-salt dietary andexercise),while control group didn’t have any lifestyle intervention.All the subjectswere collected basic clinical data such as age, height, weight, blood pressure and heartrate at the baseline, every6-month and the end of the study; blood and urine sampleswere collected to measuring biochemical parameters such as urinary sodium andblood lipid;24hours ambulatory blood pressure monitoring was carried out; centralaortic pressures were carried out noninvasively by using SphygmoCor device, andcarotid-radial pulse wave velocity (crPWV) were tested by using the Complior device. Questionnaires and knowledge, attitude and practice (KAP) score at the baseline andthe end of the study. Other, blood pressure, blood glucose and blood lipid ofintervention group were tested every3-month. New cases of hypertension, diabetesand cardiovascular outcomes were recorded every follow-up.Results:①Before treatment, basic clinical data,24hABPM, Center artery pressure, crPWVand KAP scoring have no significant difference between the two groups(P＞0.05);②Age is positively correlated with crPWV、AASI、CPP、CSP、24hSBP、DSBP、CAI、DDBP-L and NSBP; history of hypertension is positively correlated withcrPWV、DDBP-L、CAI、CSP and CDP; BMI is positively correlated with SP andcrPWV; WHtR is positively correlated with crPWV, heart rate and AASI; urinarysodium is positively correlated with crPWV、AASI、24hSBP、CSP、DSBP、DSBP-L、CAI、NSBP、NDBP、24hDBP、CPP、SP、NSBP-L and DDBP;smoking is positivelycorrelated with24hSBP、DSBP、DSBP-L、DDBP-L、NSBP、SP、crPWV、24hDBP、NDBP、DP、NDBP-L、DDBP、CSP、NSBP-L、AASI、CPP and heart rate, andnegatively correlated with SBPF; drinking is positively correlated with crPWV、NSBP、CAI、DDBP-L、AASI、NDBP-L、CPP、heart rate、NDBP and24hSBP, andnegatively correlated with SBPF and DBPF;③Multiple liner regression showed that:24hSBP (mmHg)=113.33+10.01×smoking(drops/day)+3.39×drinking(ml/day)+0.25×SP(mmHg)-0.20×DP(mmHg)+0.05×urinary sodium (mmol/L), smoking, alcohol consumption, SP, DP and urine sodium weremain risk factors for24hSBP;24hDBP (mmHg)=74.24+3.87×smoking(drops/day)+2.55×drinking(ml/day)-1.46×FBG(mmol/L)+0.23×DP(mmHg)+0.04×urinary sodium(mmol/L), smoking, alcohol consumption, FBG, DP and urine sodium were main riskfactors for24hDBP; SBPF (%)=26.84-3.4×drinking (ml/day), alcohol consumptionwas main risk factor for SBPF; DBPF (%)=10.18-2.86×drinking (ml/day), alcoholconsumption was main risk factor for DBPF; AASI (%)=0.09-0.005×DP(mmHg)+0.002×urinary sodium (mmol/L), DP and urine sodium were main risk factors forAASI; AI (%)=58.98+0.4×SP(mmHg)+0.16×urinary sodium (mmol/L), SP and urinesodium were main risk factors for AI; CSP (mmHg)=-6.67+2.87×drinking(ml/day) +0.89×SP(mmHg)+0.06×urinary sodium (mmol/L), drinking, SP and urine sodiumwere main risk factors for CSP; CDP (mmHg)=14.39+0.78×DP(mmHg)+0.47×BMI(kg/m2)+0.1×SP(mmHg), DP, BMI and SP were main risk factors for CDP;crPWV (m/s)=5.35-1.77×HDL-C(mmol/L)+0.9×smoking (drops/day)+0.83×TC(mmol/L)+0.06×age(year)+0.02×urinary sodium (mmol/L), HDL-C, smoking, TC,age and urine sodium were main risk factors for crPWV;④After treatment, TG, heart rate, BP, urine sodium and urine potassium weredecreased in control group; BMI, WHtR, heart rate, BP, uric acid, TC, TG and urinesodium were decreased in intervention group; After treatment, the reducing extent ofBMI, WHtR, TC, TG and urine sodium in intervention group were higher than that incontrol group; the rates of decline of WHtR, TC and urinary sodium in interventiongroup were greater than the control group(P＜0.05).⑤After treatment,24hSBP, DSBP, DDBP, NSBP and DSBP-L were decreased incontrol group;24hSBP, DSBP, DDBP, NDBP, DSBP-L, NSBP-L, SBPF and DBPFwere decreased in intervention group, DDBP-L were increased in intervention group;after treatment, the changing extent of24hDBP, DSBP, DDBP, DSBP-L, NSBP-L,DDBP-L, SBPF and DBPF in intervention group were higher than that in controlgroup; after treatment, the rates of decline of24hDBP, DSBP, DDBP, NSBP-L andSBPF in intervention group were greater than the control group(P＜0.05).⑥After treatment, PWV, CPP and AI were decreased in control group; PWV, CSP,CDP, AI were decreased in intervention group; after treatment, both reducing extentand declining rates of CSP, CDP in intervention group were greater than that incontrol group(P＜0.05).⑦After treatment, KAP scored was increased in intervention group, while there is nosignificant difference in control group; After treatment, both rising extent and risingrates of KAP scored in intervention group were greater than that in the control group(P＜0.05).⑧At the end of the study, the total quantities of complications of heart, head, kidneyand cardiovascular outcomes of intervention group were lower apparently than controlgroup (P <0.05). Conclusion:①Lifestyle interventions were closely related to subclinical detection indicators(include the blood pressure indicators and the arteriosclerosis indicators).②Therapeutic lifestyle interventions could improve the metabolic of blood pressureand lipids significantly;③The flexible functions of microvascular and macrovascular were be improved bytherapeutic lifestyle interventions, and the crPWV, AASI and AI were reducedapparently.④Therapeutic lifestyle interventions can reduce the Central aortic pressure.⑤Therapeutic lifestyle intervention may correct circadian rhythm of24hABPM.⑥Therapeutic lifestyle intervention can improve knowledge, attitude and practice ofhypertension patients.⑦Therapeutic lifestyle interventions can reduce the new complications of heart，head，kidney and cardiovascular outcomes in hypertension patients.