{"id":"2d4ae974532c","type":"article","url":"https://hartvaat.nl/2021/10/12/leefstijlmodificatie-bij-resistente-hypertensie-triumph-gerandomiseerde-trial/","title":"Leefstijlmodificatie bij resistente hypertensie: TRIUMPH gerandomiseerde trial","title_en":"Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["aprocitentan","bax24-trial","bloeddrukbehandeling","figaro-dkd","lorundrostat","precision-trial","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","select-trial","summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055329","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055329","authors":["James A Blumenthal","Alan L Hinderliter","Patrick J Smith","Stephanie Mabe","Lana L Watkins","Linda Craighead","Krista Ingle","Crystal Tyson","Pao-Hwa Lin","William E Kraus","Lawrence Liao","Andrew Sherwood"],"significance":7,"published":"2021-10-12","source_date":"2021-10-12","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The TRIUMPH randomized trial showed that lifestyle modifications (dietary counseling, exercise, weight loss) significantly reduce blood pressure in patients with resistant hypertension already on pharmacotherapy, demonstrating that non-pharmacological approaches retain benefit even in treatment-resistant disease.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TRIUMPH gerandomiseerde trial die het effect van leefstijlmodificatie onderzocht bij patiënten met resistente hypertensie.","abstract_original":"BACKGROUND: Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown. METHODS: One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure. RESULTS: Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (-12.5 [95% CI, -14.9 to -10.2] mm Hg) compared with SEPA(-7.1 [-95% CI, 10.4 to -3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (-7.0 [95% CI, -8.5 to -4.0] mm Hg), with no change in SEPA (-0.3 [95% CI, -4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus -1.1 ms/mm Hg [95% CI, -2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus -0.2 ln ms2 [95% CI, -0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, -0.3 to 1.0] versus -1.4% [95% CI, -2.5 to -0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596). CONCLUSIONS: Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808."}