Diabetes Diet Could Also Lower BP

Patients who lost weight and kept it off after beginning a low-energy diet designed to induce diabetes remission were also able to discontinue antihypertensive medications, according to a recent post-hoc analysis.

The researchers used data from patients who participated in the intervention arm of the Diabetes Remission Clinical Trial (n = 143) as well as a subset of patients who discontinued antihypertensives at the start of the study (n = 69). The diet consisted of 830 kcal per day and was designed to achieve rapid weight loss over 12-20 weeks. Patients underwent regular blood pressure monitoring during the study. Of the 143 intervention group, 78 were being treated for hypertension at baseline.

The overall mean blood pressure fell significantly from week 1 to week 20 and remained low at 12 and 24 months. Of 78 patients treated for hypertension at baseline, 65 (83%) stopped all hypertensive and diuretic treatments, while 4 continued taking some drugs. Among these 69 patients, mean blood pressure fell significantly following week 9 of the intervention after experiencing no significant immediate changes.

Antihypertensives were reintroduce in 19 of the 69 patients (27.5%) to manage elevated blood pressure, mostly within the first 3 to 7 weeks. A total of 19 patients remained off of all medications for 24 months.

Among patients who had sustained diabetes remission at 24 months, 31 had been previously treated for hypertension, 27 of whom stopped medication at baseline and 15 of whom required reintroduction to treatment during the study.

Fifty-one patients reported mild to moderate dizziness during the study, 15 of whom had reported dizziness at baseline before starting the dietary intervention.

“Replacing antihypertensive medications with a 3470 kJ/day (830 kcal) diet to induce weight loss reduces blood pressure substantially and may increase mild dizziness. It is safe to stop antihypertensives, but blood pressure should be monitored regularly, particularly for those taking two or more antihypertensives, as over two-thirds will require reintroduction of some medications. Long-term support to maintain weight loss is vital,” the researchers concluded.

—Michael Potts

Reference:

Leslie WS, Ali E, Harris L, et al. Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT). Published May 31, 2021. Diabetologia. https://doi.org/10.1007/s00125-021-05471-x