单独采用得舒饮食以及联合运动和体重减轻对高血压男性和女性血压及心血管生物标志物的影响：ENCORE研究
Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study.
作者信息
Blumenthal James A, Babyak Michael A, Hinderliter Alan, Watkins Lana L, Craighead Linda, Lin Pao-Hwa, Caccia Carla, Johnson Julie, Waugh Robert, Sherwood Andrew
机构信息
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Campus Box 3119, Durham, NC 27710, USA.
出版信息
Arch Intern Med. 2010 Jan 25;170(2):126-35. doi: 10.1001/archinternmed.2009.470.
BACKGROUND
Although the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to lower blood pressure (BP) in short-term feeding studies, it has not been shown to lower BP among free-living individuals, nor has it been shown to alter cardiovascular biomarkers of risk.
OBJECTIVE
To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension (systolic BP, 130-159 mm Hg; or diastolic BP, 85-99 mm Hg).
DESIGN AND SETTING
Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008.
PARTICIPANTS
Overweight or obese, unmedicated outpatients with high BP (N = 144).
INTERVENTIONS
Usual diet controls, DASH diet alone, and DASH diet plus weight management.
OUTCOME MEASURES
The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring. Secondary outcomes included pulse wave velocity, flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass.
RESULTS
Clinic-measured BP was reduced by 16.1/9.9 mm Hg (DASH plus weight management); 11.2/7.5 mm (DASH alone); and 3.4/3.8 mm (usual diet controls) (P < .001). A similar pattern was observed for ambulatory BP (P < .05). Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity, baroreflex sensitivity, and left ventricular mass (all P < .05).
CONCLUSION
For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.
CLINICAL TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00571844.
背景
尽管在短期喂养研究中已证明得舒饮食（DASH饮食，即终止高血压的饮食疗法）可降低血压，但尚未证明其在自由生活的个体中能降低血压，也未证明其能改变心血管风险生物标志物。
目的
在患有高血压前期或1期高血压（收缩压130 - 159 mmHg；或舒张压85 - 99 mmHg）的参与者中，比较单独的得舒饮食或联合体重管理计划与常规饮食控制的效果。
设计与地点
在一家三级医疗中心进行的随机对照试验，在基线和4个月时进行评估。招募于2003年10月29日开始，2008年7月28日结束。
参与者
超重或肥胖、未接受药物治疗的高血压门诊患者（N = 144）。
干预措施
常规饮食控制、单独的得舒饮食以及得舒饮食加体重管理。
结局指标
主要结局指标是在诊所测量的血压以及通过动态血压监测测量的血压。次要结局包括脉搏波速度、肱动脉血流介导的舒张功能、压力反射敏感性和左心室质量。
结果
诊所测量的血压降低情况为：得舒饮食加体重管理组降低16.1/9.9 mmHg；单独得舒饮食组降低11.2/7.5 mmHg；常规饮食控制组降低3.4/3.8 mmHg（P < .001）。动态血压监测也观察到类似模式（P < .05）。与单独得舒饮食相比，得舒饮食加体重管理在脉搏波速度、压力反射敏感性和左心室质量方面有更大改善（均P < .05）。
结论
对于血压高于正常的超重或肥胖者，在得舒饮食基础上增加运动和体重减轻可使血压降低幅度更大，血管和自主神经功能改善更明显，并减少左心室质量。
临床试验注册
clinicaltrials.gov标识符：NCT00571844。
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