Effects of Complex Therapy with Lifestyle Modification in Patients with Hypertension and Obesity

Abstract

Obesity is a global problem of the modern working population and a negative factor in the development of hypertension. In obese patients, adipose tissue dysfunction leads to increased leptin secretion. Failure to treat in time leads to complications and deterioration of quality of life. Therefore, it is important to prevent and treat both conditions, primarily in terms of lifestyle adjustments.

The objective: to investigate anthropometric, morphometric, biochemical parameters and quality of life of patients with obesity and hypertension on the background of standard and modified therapy with lifestyle adjustments.

Materials and methods. Analysis of the results of treatment of 128 patients with hypertension I–II stage and 1–2 degrees and obesity (mean age 48.4±0.9 years) and as a control examined 21 relatively healthy people. After the first examination, patients with hypertension and obesity were divided into two groups – main (group 1) and experimental (group 2). Patients in both groups received standard antihypertensive therapy (ACE inhibitors, calcium channel blockers, thiazide diuretics) and received dietary and exercise recommendations, smoking cessation, salt restriction to 5 mg / day, and alcohol reduction.

In contrast to the experimental group (group 2), patients of the main group (group 1) received individual dietary recommendations in the form of DASH-diet, the energy value of which was daily energy needs reduced by 300–400 kcal and omega-3 PUFA at a dose of 1007 mg (Including: eicosapentaenoic acid – 33% docosahexaenoic acid – 22%), coenzyme Q10 – 10 mg, vitamin E – 3 mg 1 g/d for 60 days. When assigning patients to the main (group 1) and experimental group (group 2), in addition to age, sex, physical activity, also took into account the compliance of patients to lifestyle changes, which was assessed on a 5-point system. Patients who were more willing and more motivated to follow the full recommendations of nutrition, increased physical activity, and those who had a higher rate of compliance were assigned to the main group.

Approaches to exercise recommendations were the same in both groups – at least 90 minutes / week or 30 minutes / 3 times a week, or at least 10,000 steps daily. Before and after treatment, a laboratory biochemical study of blood and urine parameters and determination of leptin levels. Quality of life was assessed by the SF-36 questionnaire.

Results. In obese patients % FM and BMI on average 1.4–1.5 times higher than the control group (38.6±0.7; р<0.001; 32.3±0.3 kg/m²; р<0.001). According to the results of repeated examination, normalization of blood pressure was achieved in all patients, regardless of treatment tactics. In 28 people from the experimental group (group 2), the average weight increased by 1–5 kg, decreased in 9 people, in the other 27 did not change (Me 0.0; Min –16.0; Max 10.0; р=0.01). In the main group (group 1), weight loss was found in 20 men and 28 women, ie in 75% of patients (–3.0±0.3 kg; р<0.01, Me –3.0; Min –0.7; Max –11.0) and although these results were lower than expected, we can conclude that there was a greater effect on weight loss in patients who followed a modified treatment regimen with lifestyle adjustments.

BMI in the dynamics of treatment in both groups did not change significantly, although in the main group there was a significant statistical decrease in % FM (–2.3±0.6; р<0.01), additionally found a statistically significant difference between the groups (р<0.01). Anthropometric parameters decreased significantly in the main group of patients, mainly due to waist circumference (in 26 patients; р<0.01).

The components of quality of life PF, RP, BP, reflecting the physical activity of patients, and components VT, SF, RE, which are the result of the psycho-emotional state of patients, were significantly lower than those of the control group. At the end of the course of treatment, the indicators of PF components in the experimental group and additionally RP, BP, SF and RE in the main group significantly improved. Analysis of leptin levels in obese patients showed herder dependence: in men with grade 2 and 3 obesity, hormone levels increased significantly compared with women and men with a BMI <35 kg/m.

Conclusions. Obesity is pathogenetically associated with adipose tissue dysfunction: 56.2% of people have increased serum leptin levels and its level does not decrease significantly with weight loss, which is probably associated with a symptom complex of psycho-physiological changes that negatively affect quality of life patients and their commitment to treatment.

Treatment of obesity by adjusting lifestyle, exercise, low-calorie DASH-diet was reflected in improved quality of life and reduced the weight of 75% of patients in the main group (group 1).