Yasemin Kaya, Harun Düğeroğlu, Ahmet Karataş, Muhammet Özbilen

Prehipertansif hastalarda DASH diyeti ve egzersizin metabolik parametreler üzerine etkisi

Amaç: Prehipertansif hastalarda kan basıncını kontrol altına almak ve hipertansiyona gidişi önlemek için önerilen DASH (Dietary Approaches to Stop Hypertension) diyeti ve egzersizin biyokimyasal parametreler üzerine etkisinin olup olmadığının araştırılması amaçlandı. Materyal Metod: Çalışmamıza 52 prehipertansif birey alındı. Sekonder hipertansiyonu, diabetes mellitusu ve tiroid bozuklukları olanlar ile antihipertansif ilaç kullananlar çalışma dışı bırakıldı. Çalışmanın başında bireylerin boy, kilo, bel çevresi (BÇ), sistolik ve diastolik kan basınçları ölçüldü. Vücut kitle indeksleri (VKI) hesaplandı. Biyokimyasal parametrelerden açlık serum glukozu, lipid düzeyleri, açlık serum insülini, hs-CRP, kreatinin, homosistein çalışıldı. HOMA-IR formülü ile insülin direnci ve MDRD (Modification of Diet in Renal Disease) formülü ile glomerüler filtrasyon hızı (GFR) hesaplandı. Oral glukoz tolerans testleri yapıldı. Spot idrarda mikroalbumin ve idrar kreatinin ölçümü yapıldı. Hastalara 6 ay DASH diyeti ve egzersiz önerildi. Hastaların 6 ay sonra yapılan kontrollerinde başlangıçta yapılan parametreler tekrar analiz edildi. Bulgular: Elli iki hastanın yaş ortalaması 38±7.6 yıl idi ve % 67’si kadındı. Diyet ve egzersiz tedavisi sonrası sistolik ve diastolik kan basınçlarında, kilo, BÇ, VKI, total kolesterol, LDL kolesterol, trigliserid, açlık insülin düzeyi, insülin direncinde ve homosisteinde istatistiksel olarak anlamlı düşme, GFR de yükselme bulundu (sırasıyla; p<0.001, p=0.003, p<0.001, p<0.001, p<0.001, p= 0.006, p=0.009, p=0.039, p<0.001, p=0.003, p=0.001, p<0.001).Sonuç: DASH diyeti ve egzersizin prehipertansif bireylerde metabolik parametreleri düzeltici etkisi gösterilmiştir.

Anahtar Kelimeler:

Prehipertansiyon, metabolik bozukluk, DASH diyeti

Effects of DASH dietary and exercise on metabolic parameters in prehypertensive patients

Objective: The aim of this study is to investigate the effects of exercise and DASH (Dietary Approaches to Stop Hypertension) diet that is proposed in order to control blood pressure and to prevent hypertension on biochemical parameters in prehypertensive patients. Material Method: Fifty two prehypertensive individuals were included in the study. Patients with secondary hypertension, diabetes mellitus and thyroid disorders and receiving antihypertensive treatment were excluded from the study. At the beginning of the study, the height, weight, waist circumference (BW), systolic and diastolic blood pressures of the individuals were measured. Body mass indexes (BMI) were calculated. Fasting blood glucose, fasting lipid levels, fasting serum insulin, hs-CRP, creatinine, homocysteine were analyzed. Insulin resistance was calculated with The HOMA-IR formula and the glomerular filtration rate (GFR) was calculated with the Modification of Diet in Renal Disease (MDRD) Formula. Oral glucose tolerance test was performed. Microalbumin and urine creatinine were measured in the spot urine. DASH diet and exercise were suggested to patients during six months. Initial parameters were repeated at 6 month later.Results: The mean age of fifty-two patients was 38 ± 7.6 years and 67% were female. Systolic and diastolic blood pressures, weight, BW, BMI, total cholesterol, LDL cholesterol, triglyceride, fasting insulin level, insulin resistance and homocysteine decreased significantly and GFR increased significantly after diet and exercise treatment (respectively; p<0.001, p=0.003, p<0.001, p<0.001, p<0.001, p= 0.006, p=0.009, p=0.039, p<0.001, p=0.003, p=0.001, p<0.001). Conclusion: It has been shown that DASH diet and exercise have corrective effects on metabolic parameters in prehypertensive individuals.

Keywords:

Prehypertension, metabolic disorder, DASH diet,

PDF

___

1.James PA, Ortiz E, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: (JNC8). JAMA. 2014 Feb 5;311(5):507-20
2.Sacks FM, Svetkey LP, Vollmer WM et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001 Jan 4;344(1):3-10.
3. Appel LJ, Moore TJ, Obarzanek E et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997 Apr 17;336(16):1117-24
4.American College of Sports Medicine Position Stand, “Exercise and Hypertension”. Med Sci Sports Exerc., 36(3):533–552, 2004
5.Somers KV., Conway J., Johnston J. Et al. “Effects of endurance training on baroreflex sensitivity and blood pressure in borderline hypertension. Lancet. 337:1363-8
6.Vaitkevicius PV., Fleg JL., Engel JH. et al., “Effects of age and aerobic capacity on arterial stiffness in healthy adults”. Circulation, 88: 1456–1462, 1993.
7. Apel LJ. Lifestyle Modification as a Means to Prevent and Treat High Blood Pressure. J Am Soc Nephrol 2003;14: 99– 102
8. Miller ER, Erlinger TP, Young DR, Jehn M, Charleston J, Rhodes D, et al. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002; 40: 612- 618
9. Paul R. Conlin Dietary modification and changes in blood pressure. Current Opinion in Nephrology and Hypertension 2001;10: 359- 363
10. Metabolik Sendrom Kılavuzu Editorler: Metin Arslan Ayşegül Atmaca Göksun Ayvaz ve ark. Türkiye Endokrinoloji ve Metabolizma Derneği • 2009
11. Açıkgöz H. E.,Tüysüz Ö., Sarandöl E. Ve ark. Glomerüler Filtrasyon Hızı Tahmininde MDRD Formülünün Kreatinin Klirensi ile Karşılaştırılması. Türk Klinik Biyokimya Derg 2013; 11(1): 21-29.
12. Erdoğan D, Yildirim İ, Çiftçi Ö. Effects of Normal Blood Pressure, Prehypertension and Hypertension on Coronary Microvascular Function. Circulation 2007;115: 593-599
13. Black HR, Bakris GL, Eliot WJ. Hipertansiyon: Epidemiyoloji, Patofizyoloji, Tanı ve Tedavi. In: Fuster V, Alexander RW, O’rourke RA. edits. The Heart. 2002: 1553- 1573
14. Sacks FM, Appel LJ, Moore TJ et al. A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clin Cardiol. 1999;22: III6-10
15. Svetkey LP, Simons- Morton D, Vollmer WM, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch Intern Med 1999; 159:285- 293.
16. Miller ER, Erlinger TP, Young DR et al. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002;40; 612- 618
17. Bao DQ, Trevor AM, Burke V et al.. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. Hypertension 1998; 32: 710- 717.
18. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and M arkers of Vascular Inflammation in the Metabolic Syndrome. JAMA 2004;4(292): 22- 29
19. Whelton SP, Chin A, Xin X, He J. Effect of Aerobic Exercise on Blood Pressure: A Meta-Analysis of Randomized, Controlled Trials. Ann Intern Med. 2002;136: 493- 503.
20. Erlinger TP, Miller III ER, Charleston J et al.. Inflammation Modifies the Effects of a Reduced-Fat Low-Cholesterol Diet on Lipids Results From the DASH-Sodium Trial. Circulation. 2003;108: 150- 154
21. Obarzane E, Sacks FM, Vollmer WM et al., Effects on blood lipids of a blood pressure–lowering diet:the Dietary Approaches to Stop Hypertension (DASH) Trial1–3.Am J Clin Nutr 2001;74: 80– 9.
22. Soydam İ. Hipertansiyonla İlgili TEKHARF Çalışması Verileri ve Yorumu. In: Onat A. Türk Erişkinlerinde Kalp Sağlığı. 2005; 60- 71
23. Apel LJ. Lifestyle Modification as a Means to Prevent and Treat High Blood Pressure. J Am Soc Nephrol 2003;14: 99– 102
24. Kannel WB, Wilson P-WF. Hipertansiyon, makrovasküler hastalık ve diabetes mellitus: Framingham Çalışması’ndan Bakışlar. In: Williams B. edit. Hypertension In Diabetes. 2003; 25- 41
25. Knight EL, Kramer HM, Curhan GC. High-normal blood pressure and microalbuminuria. Am J Kidney Dis. 2003;41: 588 –595.
26. Thorell A, Hirshman MF, Nygren J, et al. Exercise and insulin cause GLUT-4 translocation in human skeletal muscle. Am J Physiol. 1999 Oct;277(4 Pt 1):E733-41
27. Işıldak M, Güven GS, Gürlek A. Metabolik Sendrom ve İnsülin Direnci. Hacettepe Tıp Dergisi 2004; 35: 96- 99
28. Ard JD, Grambow SC, Liu D et al.. The Effect of the PREMIER Interventions on Insulin Sensitivity. Diabetes Care, 2004;27: 340–347
29. Kannel WB, Wilson P-WF. Hipertansiyon, makrovasküler hastalık ve diabetes mellitus: Framingham Çalışması’ndan Bakışlar. In: Williams B. edit. Hypertension In Diabetes. 2003; 25- 41
30. Ma Y,Griffith JA, Chasan-Taber L et al. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr 2006;83: 760–6
31. Svetkey LP. Managment of Prehypertension. Hypertension 2005;45: 1056- 1061
32. Borghi C, Dormi A, Ambrosioni E et al. Relative role of systolic, diastolic and pulse pressure as risk factors for cardiovascular events in the Brisighella Heart Study. J Hypertens 2002; 20: 1737.
33. Qureshi AI, Suri MF, Kirmani JF et al. Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med Sci Monit 2005;11: 403- 409.
34. Grotto I, Grossman E, Huerta M. Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles Among Young Israeli Adults. Hypertension 2006; 48: 254- 259
35.Williams B. Epidemiology and Pathogenesis of Hypertension at Diabetic Patients. In: Williams B. edit. Hypertension In Diabetes. 2003; 3- 23
36.Onat A. Halkımızda İnsülin Direncinin Bazı Yansıtıcıları: Visseral Adipozite, Hiperinsülinemi, HOMA ve Apolipoprotein C-III. In: Onao A edit. Türk Erişkinlerinde Kalp Sağlığı. 2005; 94- 102
37. Grotto I, Grossman E, Huerta M. Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles Among Young Israeli Adults. Hypertension 2006; 48: 254- 259
38. Tokgözoğlu L.Koroner Arter Hastalığında Yeni Risk Faktörleri In: Sabah İ.edit. Türkiye Klinikleri Kardiyoloji 2000;13: 8-11