BLOOD-PRESSURE EFFECTS OF ANTIHYPERTENSIVE DRUGS AND CHANGES IN LIFE-STYLE IN A BRAZILIAN HYPERTENSIVE COHORT

Background The antihypertensive efficacy of drug therapy and of some n onpharmacologic recommendations has been demonstrated in controlled cl inical trials, but not in a clinical setting. Objective To assess the antihypertensive effectiveness of drug therapy and of three nonpharmac ologic recommendations (loss of weight, salt-intake restriction, and p hysical exercise). Design A prospectively planned cohort study. Settin g A hospital-based hypertensive outpatient clinic. Patients We studied 637 patients (65.5% women) with systolic blood pressures above 140 mm Hg or diastolic blood pressures above 90 mmHg, corresponding to 76% of 839 patients who were administered a prescription for hypertension an d who returned for the first follow-up visit 3.5 months later on avera ge. Methods The nonpharmacologic prescription consisted of salt-intake restriction for all, weight reduction for overweight patients, and pr actice of aerobic physical exercise for those for whom it was not cont raindicated; 60% of the patients were treated with drugs according to standard recommendations. Patients treated with drugs were compared wi th untreated subjects; for the nonpharmacologic interventions, the gro ups were compared according to their reported compliances with the rec ommendations (at least some compliance versus none). The main outcome measures were variations in systolic and diastolic blood pressures bet ween the baseline evaluation and the first follow-up visit and an impr ovement in prognosis, represented by a favorable change in the classif ication of the blood pressure (according to Joint National Committee V criteria). Results The cohort constituted predominantly low-income, m iddle-aged, overweight white women, with low-to-moderate hypertension of long duration. The group treated with drugs exhibited the greatest reduction in blood pressure, with clinical significance even discounti ng the losses in follow-up; the group of patients who reported complia nce with the low-energy intake diet also showed a consistent antihyper tensive effect, which was still detectable on the occasion of the thir d follow-up visit 9 months after the first prescription; reported comp liance with a low-sodium diet and practice of physical exercise were n ot associated with a reduction in blood pressure; among a subset of th e patients, reported compliance with the salt-intake-restricted diet d id not reduce the amount of sodium to the theoretical antihypertensive threshold. It was not possible to determine whether the lack of an an tihypertensive effect of physical exercise for this cohort was seconda ry to a misreport of the extent of compliance or to an absence of effe ct of the intensity of training prescribed. The effects of drug therap y and compliance with a low energy-intake diet were shown to be indepe ndent of other interventions or confounders. Conclusion The antihypert ensive effect of drugs demonstrated in well-controlled clinical trials is achievable in clinical practice. The recommendation to lose weight was the only nonpharmacologic intervention with a detectable antihype rtensive effect in this cohort. The absence of effect of a low-sodium diet is probably secondary to the insufficient reduction in the amount of salt consumed. The lack of an antihypertensive effect of physical exercise could reflect either a misreported compliance or an absence o f effect of the intensity of training recommended in this study.