{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:02:52Z","timestamp":1792191772579,"version":"4.4.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,10,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (\u201312.5 [95% CI, \u201314.9 to \u201310.2] mm\u2009Hg) compared with SEPA(\u20137.1 [\u201395% CI, 10.4 to \u20133.7] mm\u2009Hg) (\n                      <jats:italic>P<\/jats:italic>\n                      =0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (\u20137.0 [95% CI, \u20138.5 to \u20134.0] mm\u2009Hg), with no change in SEPA (\u20130.3 [95% CI, \u20134.0 to 3.4] mm\u2009Hg) (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms\/mm\u2009Hg [95% CI, 1.3 to 3.3] versus \u20131.1 ms\/mm\u2009Hg [95% CI, \u20132.5 to 0.3];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), high-frequency heart rate variability (0.4 ln ms\n                      <jats:sup>2<\/jats:sup>\n                      [95% CI, 0.2 to 0.6] versus \u20130.2 ln ms\n                      <jats:sup>2<\/jats:sup>\n                      [95% CI, \u20130.5 to 0.1];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), and flow-mediated dilation (0.3% [95% CI, \u20130.3 to 1.0] versus \u20131.4% [95% CI, \u20132.5 to \u20130.3];\n                      <jats:italic>P<\/jats:italic>\n                      =0.022). There were no between-group differences in pulse wave velocity (\n                      <jats:italic>P<\/jats:italic>\n                      =0.958) or left ventricular mass (\n                      <jats:italic>P<\/jats:italic>\n                      =0.596).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02342808.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.121.055329","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T05:51:05Z","timestamp":1632721865000},"page":"1212-1226","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":148,"title":["Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial"],"prefix":"10.1161","volume":"144","clinical-trial-number":[{"clinical-trial-number":"nct02342808","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-0935","authenticated-orcid":true,"given":"James A.","family":"Blumenthal","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan L.","family":"Hinderliter","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of North Carolina at Chapel Hill (A.L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Mabe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana L.","family":"Watkins","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Craighead","sequence":"additional","affiliation":[{"name":"Department of Psychology, Emory University, Atlanta, GA (L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Ingle","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal","family":"Tyson","sequence":"additional","affiliation":[{"name":"Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pao-Hwa","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, 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