Liquid Diet for T2D Lowers Blood Pressure, Reduces Medication Use

The UK analysis came from a larger study that examined the effects of a liquid total diet replacement program to induce remission in type 2 diabetes (T2D).

Losing weight rapidly allowed participants with type 2 diabetes (T2D) to control their high blood pressure (BP) even as they reduced or eliminated their antihypertensive drugs, according to results of a trial involving a liquid formula diet.

The study, published in Diabetologia, is a secondary analysis of the Diabetes Remission Clinical Trial (DiRECT), an intervention tested in primary care practices in the United Kingdom.

The liquid total diet replacement (TDR) provided about 830 kcal/day with automatic reductions in all nutrients to induce rapid weight loss over 12 to 20 weeks. Antihypertensive drugs were withdrawn at the start of the diet, and BP was monitored regularly. Reintroduction of therapy was based on clinical guidelines.

Participants were randomized to intervention or a control group and all had been diagnosed with T2D within the past 6 years. Other inclusion criteria included having glycated hemoglobin ≥ 6.5%, or ≥ 6.1% if on T2D therapies, aged 18–65 years, and body mass index (BMI) 27–45 kg/m2.

Of 143 participants, 62 had no hypertension and 81 did; of those 81 patients, 78 were taking antihypertensive medications.

Of the 78, most stopped taking their medications completely as they began the diet, and 9 did not.

The overall mean BP fell significantly from the start of TDR and was significantly lower when TDR total diet replacement finished at week 20. It remained lower at 12 and 24 months

Of the 78 participants previously on treatment for hypertension, 65 (83%) stopped all antihypertensive and diuretic medications as per protocol, and 4 stopped some drugs.

These 69 participants saw no immediate change in BP, but their mean BP fell significantly from 9 weeks. While BP did not rise excessively, antihypertensive drugs were reintroduced during TDR to manage raised BP for 27.5% of the participants, even though they had some weight loss.

Participants who were on 2 drugs, as opposed to 1, were more likely to need their BP therapies reintroduced.

At 24 months, 28% of those who stopped their antihypertensive therapies remained off them.

Of the 53 participants who achieved T2D remission through the diet, 31 had been previously treated for hypertension.

The researchers said that while the protocol was safe and effective, careful BP monitoring is necessary; 51 participants reported mild to moderate dizziness during TDR, suggesting some postural hypotension. Of these participants, 15 had a history of dizziness before starting the diet.

The study was conducted by researchers at the Universities of Glasgow and Newcastle.

“We wanted to evaluate the safety and efficacy of withdrawing blood pressure medication when beginning our specially-designed weight-loss programme for type 2 diabetes, and we are really pleased with the results,” Mike Lean, MD, MA, MB, FRCPS, FRSE, clinical senior research fellow from the University of Glasgow said in a statement. “Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks.”


Leslie WS, Ali E, Harris L. et al. Antihypertensive medication needs and blood pressure control with weight loss in the Diabetes Remission Clinical Trial (DiRECT). Diabetologia. Published online May 31, 2021. doi: 10.1007/s00125-021-05471-x

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