Relationship between Cardiometabolic Factors and the Response of Blood Pressure to a One-Year Primary Care Lifestyle Intervention in Metabolic Syndrome Patients

Elisa Marin-Couture; Marie-Josée Filion; Ryma Boukari; Khursheed Jeejeebhoy; Rupinder Dhaliwal; Paula Brauer; Dawna Royall; David M Mutch; Doug Klein; Angelo Tremblay; Caroline Rhéaume

doi:10.3390/metabo12090861

Relationship between Cardiometabolic Factors and the Response of Blood Pressure to a One-Year Primary Care Lifestyle Intervention in Metabolic Syndrome Patients

Metabolites. 2022 Sep 14;12(9):861. doi: 10.3390/metabo12090861.

Authors

Elisa Marin-Couture^{1

2}, Marie-Josée Filion³, Ryma Boukari³, Khursheed Jeejeebhoy⁴, Rupinder Dhaliwal⁵, Paula Brauer⁶, Dawna Royall⁶, David M Mutch⁷, Doug Klein⁸, Angelo Tremblay^{1

2

9}, Caroline Rhéaume^{3

9

10}

Affiliations

¹ Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada.
² Centre de Recherche Nutrition, Santé et Société (NUTRISS), INAF, Quebec City, QC G1V 0A6, Canada.
³ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada.
⁴ Department of Nutritional Sciences and Physiology, University of Toronto, Toronto, ON M5S 1A4, Canada.
⁵ Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada.
⁶ Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada.
⁷ Department of Human & Health Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada.
⁸ Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada.
⁹ Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, QC G1V 4G5, Canada.
¹⁰ Centre de Recherche en Santé Durable-Vitam, CIUSS de la Capitale-Nationale, Quebec City, QC G1J 2G1, Canada.

Abstract

Systemic hypertension has been recognized as a modifiable traditional cardiovascular risk factor and influenced by many factors such as eating habits, physical activity, diabetes, and obesity. The objective of this cross-sectional study was to identify factors that predict changes in blood pressure induced by a one-year lifestyle intervention in primary care settings involving a collaboration between family physicians, dietitians, and exercise specialists. Patients with metabolic syndrome diagnosis were recruited by family physicians participating in primary care lifestyle intervention among several family care clinics across Canada. Participants for whom all cardiometabolic data at the beginning (T0) and the end (T12) of the one-year intervention were available were included in the present analysis (n = 101). Patients visited the dietitian and the exercise specialist weekly for the first three months and monthly for the last nine months. Diet quality, exercise capacity, anthropometric indicators, and cardiometabolic variables were evaluated at T0 and at T12. The intervention induced a statistically significant decrease in waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, and plasma triglycerides, and an increase in cardiorespiratory fitness (estimated VO2max). Body weight (p < 0.001), body mass index (BMI) (p < 0.001), and fasting blood glucose (p = 0.006) reduction, and VO2max increase (p = 0.048) were all related to changes in SBP. WC was the only variable for which changes were significantly correlated with those in both SBP (p < 0.0001) and DBP (p = 0.0004). Variations in DBP were not associated with changes in other cardiometabolic variables to a statistically significant extent. Twelve participants were identified as adverse responders (AR) in both SBP and DBP and displayed less favorable changes in WC. The beneficial effects of the primary care lifestyle intervention on blood pressure were significantly associated with cardiometabolic variables, especially WC. These findings suggest that a structured lifestyle intervention in primary care can help improve cardiometabolic risk factors in patients with metabolic syndrome and that WC should be systematically measured to better stratify the patient’s hypertension risk.

Keywords: adverse responders; blood pressure; cardiorespiratory fitness; lifestyle intervention; metabolic syndrome; primary care; waist circumference.

Grants and funding

The CHANGE program was funded by Metabolic Syndrome Canada (website: https://www.metabolicsyndromecanada.ca, accessed on 16 July 2022). The funding source played no role in this secondary analysis. The research of AT is partly funded by the Canada Research Chair in Environment and Energy Balance. The research of CR was supported by LE-250—partnership between Federation of general practitioners of Quebec (FMOQ)/Research Funds (FRQS) and Quebec health and Social Services.