Effects of hygienic-dietary recommendations on ambulatory blood pressure in untreated patients with grade 1 hypertension

International guidelines for the prevention and treatment of hypertension recommended hygienic-dietary intervention (including sodium restriction, weight loss, the DASH diet, limit alcohol intake, and regular aerobic exercise) as the starting non-pharmacological treatment of patients with grade-1 hypertension. A recent trial on a very small number of patients already under pharmacological antihypertensive treatment and who were required to eat once daily at the clinic, has shown the expected significant blood pressure (BP) reduction after 9 weeks of intervention with all those recommendations [Hypertension. 2002;40:612–618]. Accordingly, we have evaluated the efficacy of hygienic-dietary recommendations (HDR) in unrestricted patients with untreated hypertension. We studied 218 patients with grade 1 essential hypertension (117 men), 47.3±14.0 years of age. BP was measured by ambulatory monitoring (ABPM) at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 consecutive hours at baseline and after 3 months of HDR without pharmacological treatment. A complete clinical evaluation was also performed in all patients following the standardized protocol at the Hypertension Unit, including blood and urine tests, both before and after HDR. Results indicate the lack of statistically significant changes after 3 months of intervention in weight (mean loss of 0.2 Kg), body mass index, or waist and hip perimeters (always P>0.208). The average of six conventional BP measurements taken at the clinic was unchanged after 3 months of HDR (average reduction of 2.2 and 1.3 mm Hg for systolic and diastolic BP, respectively; P>0.122). Serum values of glucose, creatinine, cholesterol and triglycerides also remained unchanged. With regard to ABPM, results indicate a small and not statistically significant BP reduction after 3 months of HDR (0.1 and 0.3 mm Hg in the 24-hour mean of systolic and diastolic BP, respectively; P>0.608). While the beneficial effects of HDR on BP under full compliance seem unquestionable, results from this trial indicate that in real-life conditions these non-pharmacological recommendations are very poorly followed by patients with mild hypertension, thus limiting the practical use of HDR for BP control in those patients. Am J Hypertens (2004) 17, 40A–40A; doi: 10.1016/j.amjhyper.2004.03.094