Hypertension, Obesity, Abdominal, Overweight or Obesity
Conditions
Keywords
Hypertension, Lifestyle, Mediterranean diet, Physical activity, Weight loss
Brief summary
The purpose of this randomized controlled trial is to test the effects of a hypocaloric Mediterranean diet or of physical activity in participants who take at least 2 antihypertensive drugs but do not reach blood pressure treatment goal. This study is a randomized, controlled, single-center, parallel group trial with three arms: hypocaloric Mediterranean diet (MeDi), physical activity (PA), or control. The control group will receive usual care (no intervention). This study will not be blinded. The interventions will last 6 months, while the study follow-up will last 12 months. Four study visits will take place: baseline, at 3 months, at 6 months, at 12 months. The primary outcome is change in mean 24-hour ambulatory systolic blood pressure and diastolic blood pressure among groups after 6 months of intervention. Secondary and exploratory outcomes include change in other measures of blood pressure, body composition, other markers of cardiometabolic disease, inflammation markers, safety outcomes, and quality of life, among others.
Interventions
BEHAVIORALPhysical activity
Increased physical activity to the minimum recommended by health authorities (≥ 150 min of moderate intensity or ≥ 75 min of vigorous intensity aerobic PA (or an equivalent combination) and ≥ 2 days of resistance exercise a week).
BEHAVIORALHypocaloric Mediterranean diet
Energy deficit to reach 5-10% weight loss within 6 months, based on the Mediterranean diet pattern.
Sponsors
The National Association for Public Health, Norway
Oslo University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Men and women * 18 - 70 years * Taking ≥ 2 antihypertensive drugs (includes combination therapy) * Office SBP ≥ 140mmHg and/or DBP ≥ 90mmHg on two occasions * BMI 25 - 40 kg/m2 * Waist circumference ≥ 88 cm (women) or ≥ 102 cm (men) * Sedentary lifestyle (\< 150 minutes/week of moderate intensity physical activity) * Weight stable (± 5 kg in the last 6 months) * Not on a weight loss diet * Willing to comply to an intervention of either a hypocaloric Mediterranean diet or physical activity (or control) for 6 months
Exclusion criteria
* Unable to provide informed consent * Pregnant or lactating * Office BP ≥ 160/100 mmHg * Diabetes mellitus type 1 * History of cardiovascular disease (including uncompensated heart failure, recent infarction or stroke in the last 6 months, severe arrhythmia, heart failure or unstable angina pectoris) * Chronic kidney disease stages 4 or 5 * Cancer in the last 5 years * Changes in concurrent medication (anti-hypertensives, anti-diabetics, lipid-lowering drugs) in the last 3 months * Regular use of oral corticosteroids in excess of 5 mg prednisolone (or equivalent) during the last month * Use of GLP-1 analogues for \< 1 year * Drug or alcohol abuse * Eating disorders or severe dietary restrictions * Impediments to physical activity at recommended levels due to musculoskeletal and other conditions.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in 24-hour ambulatory DBP among subjects, after 6 months. | baseline to 6 months | 24-hour ambulatory blood pressure will be measured with a device that allows free-living. Change = (6 month measurement - baseline measurement). |
| Change in 24-hour ambulatory SBP among subjects, after 6 months. | Baseline to 6 months | 24-hour ambulatory blood pressure will be measured with a device that allows free-living. Change = (6 month measurement - baseline measurement). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in body composition, within and among subjects, after 6 months. | Baseline to 6 months | Office measures of body composition will include weight, waist and hip circumferences, BMI, waist-to-hip ratio, and bioimpedance analysis (BIA). Additional measures of body composition will be acquired via Dual-energy X-ray absorptiometry (DXA), including fat mass, fat-free body mass, visceral adipose tissue, subcutaneous adipose tissue, and bone mineral content and density. Change = (6 month measurement - baseline measurement) |
| Change in markers of cardiometabolic risk, within and among subjects, after 6 and 12 months. | Baseline to 6 months, baseline to 12 months | Cardiometabolic risk factors (including measures of glucose regulation, blood lipids, NORRISK 2 score, metabolic syndrome) will be measured via blood samples and additional clinical parameters. Change = (6 or 12 month measurement - baseline measurement) |
| Change in safety outcomes, within and among subjects, after 6 and 12 months. | Baseline to 6 months, baseline to 12 months | Safety outcomes will be measured via blood tests (including hematology, kidney, liver, and thyroid markers). Change = (6 or 12 month measurement - baseline measurement) |
| Change in inflammation markers, within and among subjects, after 6 and 12 months. | Baseline to 6 months, baseline to 12 months | Inflammation markers will be measured via blood tests (including CRP and differential leucocyte count). Change = (6 or 12 month measurement - baseline measurement) |
| Change in other measures of blood pressure, within and among subjects, after 6 and 12 months. | Baseline to 6 months, baseline to 12 months | Blood pressure will be measured with 24-hour ambulatory blood pressure monitors and in-office. Other measures of blood pressure include daytime blood pressure, nighttime blood pressure, and office systolic and diastolic blood pressure. Change = (6 or 12 month measurement - baseline measurement) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in quality of life, within and among subjects, after 3, 6 and 12 months. | Baseline to 6 months, baseline to 12 months | Quality of life will be measured via the EQ-5D questionnaire. |
Countries
Norway
Contacts
Primary ContactKari Anne Sveen, MD, PhD
Backup ContactAna Sousa, MSc
Outcome results
None listed