Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT)
A vascular complication of T2DM is well known. While study data reveals that all the characteristics of cardiometabolic conditions, including dyslipidemia, type 2 diabetes, and hypertension, are improved by weight loss; treatment approach for weight management has not been well recognized in clinical practice. Hence, Wilma S. Leslie and colleagues conducted research under the title “Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT)” published in the Diabetologia journal. The summary of this study is given below:
Objective:
To investigate the safety and efficacy of an organized therapeutic withdrawal of all diuretic and antihypertensive medications, while starting on a formula low-energy diet replacement, with a goal of remission of type 2 diabetes.
Method:
Post hoc analysis was conducted to record changes in antihypertensive medication prescriptions, BP, and symptoms during the initial total diet replacement phase. It was performed with 143 subjects in the intervention arm of the Diabetes Remission Clinical Trial and in 69 subjects in the subset which included patients who discontinued antihypertensive medications at the initiation of total diet replacement. 3470 kJ/day (830 kcal) was supplied through the Counterweight-Plus total diet replacement with obvious reductions in all nutrients, including sodium. The target was to achieve marked negative energy balance and rapid weight loss over the period of 12–20 weeks. Regular BP monitoring and an antihypertensive reintroduction protocol were followed as per the current clinical guidelines.
Findings:
The study concludes that all patients initiated on antihypertensive drugs are not required to continue them indefinitely. Additionally, improved BP was recorded with weight loss intervention and withdrawal of antihypertensive drugs. On the other hand, medications were reintroduced as per the requirement for about one-third of participants during total diet replacement (TDR). There were no serious adverse events reported related to rises in BP.
For individuals who achieve remission, it is important that BP and HbA1c should be monitored at least annually because even without weight regain BP often rises with age.
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