Impact of Lifestyle Medicine Interventions on the Management of Systemic Hypertension in Primary Care: A Canadian Randomized Controlled Trial

DOI: 10.1177/15598276241242013. Department of Kinesiology, Faculty of Medicine, Universit ´e Laval, Qu ´ebec, QC, Canada (EMC, JPD, NA, AT); Centre de Recherche Nutrition, Santé et Société (NUTRISS), INAF, Université Laval, Québec, QC, Canada (EMC, AT); VITAM – Centre de Recherche en Santé Durable, Québec, QC, Canada (EMC, JAM, JPD, CC, JSP, CR); Family Medicine Teaching Unit (Groupe de Médecin de Famille Universitaire: GMF-U Quatre Bourgeois), Québec, QC, Canada (AST, CR); Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada (AST, JSP, CR); Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada (PP, JPD, AG, VL, NA, IL, MCG, MEP, BJA, AT, CR); Faculty of Pharmacy, Université Laval, Québec, QC, Canada (PP); Faculty of Nursing, Université Laval, QC, Canada (MCG); Department of Medicine, Faculty of Medicine, Université Laval, QC, Canada (BJA); and Primary Care Research and Innovation Laboratory (Laboratoire ARIMED), Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, Joliette, QC, Canada (JSP).

ABSTRACT
The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T0 and T6, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T6. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension.

KEYWORDS

hypertension; lifestyle medicine; primary care; medication