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The American College of Cardiology 58 th Annual Scientific Session

The ENCORE Study Cardiovascular Benefits Associated With the DASH Diet Alone and in Combination with Exercise and Weight Reduction in Men and Women with High Blood Pressure. The American College of Cardiology 58 th Annual Scientific Session. Alan L. Hinderliter, MD. Conflicts of Interest.

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The American College of Cardiology 58 th Annual Scientific Session

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  1. The ENCORE StudyCardiovascular Benefits Associated With the DASH Diet Alone and in Combination with Exercise and Weight Reduction in Men and Women with High Blood Pressure The American College of Cardiology 58th Annual Scientific Session Alan L. Hinderliter, MD

  2. Conflicts of Interest The authors have no relevant conflicts of interest

  3. Background Lifestyle modifications are recommended for blood pressure lowering in patients with pre-hypertension and as an initial strategy in treating Stage I hypertension The DASH diet is effective in lowering blood pressure In patients on the DASH diet, the incremental benefits of weight loss and exercise are uncertain The effects of lifestyle modifications on cardiovascular manifestations of high blood pressure have not been extensively studied

  4. Objectives To examine the effects of 1) the DASH diet, and 2) the DASH diet plus exercise and weight loss on blood pressure in overweight patients with high blood pressure To examine the effects of lifestyle modifications on cardiovascular manifestations of high blood pressure

  5. Study population Overweight but otherwise generally healthy adults with above-optimal blood pressure Inclusion criteria Age > 35 years BMI 25-40 kg/m2 Sedentary (not engaged in regular exercise) BP 130-159/85-99 mmHg Exclusion criteria Treatment with antihypertensive medication Secondary hypertension Cardiac disease, diabetes, or chronic kidney disease

  6. Interventions Subjects were randomized to one of three interventions for 16 weeks: DASH diet alone 2-week feeding period plus weekly group sessions Diet designed to maintain weight DASH diet plus behavioral weight management program DASH diet plus weekly sessions to implement cognitive behavioral weight loss program Supervised exercise three times weekly Usual Care

  7. Outcome measures Primary outcome measure Resting blood pressure Secondary outcome measure Ambulatory blood pressure Vascular stiffness (pulse wave velocity) Endothelial function (flow-mediated dilation) Left ventricular mass (echocardiography)

  8. Baseline characteristics Values are mean (SD) unless otherwise specified

  9. Subject retention and adherence • Drop-outs: 4 • 3 in DASH + WM • 1 in Usual Care • DASH dietary class attendance: 92% • Exercise session attendance: 90%

  10. Dietary Intake Values are medians unless otherwise specified

  11. WeightAdjusted means after treatment Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p < .001

  12. Aerobic CapacityAdjusted means after treatment Treadmill Time Peak VO2 Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p < .001

  13. Resting Blood PressureAdjusted means after treatment Systolic Diastolic Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p = .023 Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p = .048

  14. Resting Blood PressureChange in Blood Pressure from Baseline

  15. Ambulatory Blood PressureAdjusted Means After Treatment Systolic Diastolic Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p = .012 Treatment v Usual Care: p < .001 DASH + WM v DASH Alone: p = .026

  16. Vascular stiffness and endothelial functionAdjusted Means After Treatment Pulse Wave Velocity Flow-Mediated Dilation Treatment v Usual Care: p = .002 DASH + WM v DASH Alone: p = .033 Treatment v Usual Care: p < .059 DASH + WM v DASH Alone: p = .989

  17. Left ventricular mass indexAdjusted Means After Treatment Treatment v Usual Care: p = .202 DASH + WM v DASH Alone: p = .016

  18. Conclusions In our study of overweight patients with high blood pressure, The DASH diet resulted in significant blood pressure lowering Exercise and weight loss in addition to the DASH diet resulted in an incremental decrease in blood pressure, as well as greater improvements in cardiovascular manifestations of high blood pressure

  19. Additional slides

  20. Resting Blood PressurePairwise Group Differences After Treatment Systolic Diastolic

  21. Autonomic FunctionAdjusted Means After Treatment Baroreflex Sensitivity Treatment v Usual Care: p = .216 DASH + WM v DASH Alone: p = .047

  22. Glucose Metabolism Glucose Tolerance Test 180 160 140 135 mg/dL 134 120 113 DASH + WM 100 DASH Alone 92 Usual Care 90 87 80 0 30 60 90 120 Minutes

  23. Resting Systolic Blood Pressure

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