Prioritizing Health | Lowering BP Without Drugs
A practice of positivity among patients with hypertension and a dental device for patients with moderate-to-severe obstructive sleep apnea (OSA) and hypertension are effective approaches to lower blood pressure (BP) based on results from two trials presented at ACC.24.
The FEEL study found that 12 weeks of daily smartphone messages designed to cultivate spirituality and promote reflection was associated with a reduction in systolic BP and improvement in flow-mediated dilation (FMD). In the study conducted in Brazil, 100 patients with stage 1 or 2 hypertension were randomized to usual care or usual care plus the intervention delivered via daily WhatsApp messages and videos encouraging reflection and focusing on optimism, gratitude and forgiveness. Occasionally this group was asked to complete brief tasks, such as writing messages of gratitude.
Office SBP, the primary endpoint, was reduced by 7.6 mm Hg with the intervention compared with an increase of 0.55 mm Hg with usual care. Percentage change in FMD increased by 4.12% in the intervention group compared with a decrease of 3.34% in the control group.
"This 7 mm Hg drop [in systolic BP] is a larger reduction than has been seen with other nonpharmacological interventions and may even outperform some drugs," said Maria Emília Teixeira, MD, PhD, the study's lead author. "With this significant level of reduction in [BP], you would potentially be able to live longer with a lower chance of heart attack, kidney diseases, stroke or disability later in life." Larger studies are needed to confirm the observed benefits.
Visit ACC.org/ACC2024 to read more about these studies and access all the coverage from ACC.24.
In the CRESCENT trial, a mandibular advancement device (MAD) was found to be noninferior to continuous positive airway pressure (CPAP) in lowering mean arterial blood pressure (MABP) in patients with moderate-to-severe OSA and hypertension. The study by Yi-Hui Ou, BSc, et al., was simultaneously published in JACC.
Conducted in Singapore, the study randomized 220 participants with a median age of 61 years (mostly men and Asian) to the MAD or CPAP. At baseline and six-month follow-up, they underwent 24-hour ambulatory BP monitoring, an Epworth Sleepiness Scale questionnaire survey and blood tests for cardiovascular biomarkers.
A 2.5 mm Hg decrease in the primary endpoint of 24-hour MABP was achieved in the MAD group, compared with no significant change with CPAP. A larger between-group reduction in all secondary ambulatory BP parameters was also seen with the MAD, with "the most pronounced effects in the asleep BP parameters." No difference was seen between groups for daytime sleepiness or cardiovascular biomarkers. Adherence was higher for the MAD than the CPAP device (56.5% vs. 23.2%).
Noting the between-group difference favoring MAD for asleep BP, the authors write it supports its use as an effective first-line alternative to CPAP. The researchers also note the results underscore the importance of treating sleep apnea as part of a broader effort to control hypertension and reduce cardiovascular risk.
Do They Know?
How may individuals know they have or are at risk of heart disease? Turns out, even in a population that one thinks of being more aware of their health – athletes – awareness is low. The HUDDLE study found a substantial gap between self-reports of cardiovascular disease among former players in the National Football League (NFL) and a "surprisingly high" prevalence of hypertension, with a "significant discrepancy between participants' awareness and observed disease prevalence."
Only 37.5% of the 285 former NFL players at screening events reported a history of hypertension – while 89.8% of participants were estimated to have high BP. High cholesterol was self-reported by 32.6%, coronary artery disease by 6.3% and history of heart failure by 2.1%, and 169 former players (59.3%) reported taking cardiovascular medications. Abnormal EKGs, defined as presence of one or more prognostic finding, were observed in 46.1% of former players.
Additionally, 61.8% of participants had structural cardiac abnormalities on transthoracic echocardiography (TTE). "Early TTE screening may offer a significant benefit for this over 50 population by assessing for structural pathologies, facilitating timely referrals, and mitigating the consequences of undiagnosed cardiovascular disease," write Alexis K. Okoh, MD, et al., in the simultaneous publication in JACC. They also note the discrepancy "in awareness and prevalence of hypertension presents an opportunity for impactful population-based health intervention."
Gamification, Incentives Increase Activity
Strategies such as earning points or small amounts of money encouraged people at high risk for heart disease or stroke to increase their daily walking by about 10% and sustain the increase for a year. The late-breaking BE ACTIVE trial tested the effect of techniques from behavioral economics such as gamification, which included competition and point scoring, and financial incentives, where small amounts of money are gained or lost in relation to behavior, on activity levels.
In nearly 1,100 individuals using a wearable device, the greatest increase in daily steps was among those randomized to the gamification plus financial incentive arm, followed by the gamification arm and the financial incentive arm (868 vs. 538 vs. 492 steps).
"This is one of the largest and longest-duration randomized trials of a home-based intervention to promote physical activity," write Alexander C. Fanaroff, MD, MHS, et al., and it "could be another tool to help reduce cardiovascular risk."
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Exercise, Hypertension
Keywords: Cardiology Magazine, ACC Publications, Hypertension, Athletes, Blood Pressure, Spirituality, Exercise
