Web-Based Lifestyle Counseling Leads to 10-point Reduction in Systolic Blood Pressure

Participants in an online behavioral intervention for high blood pressure had a greater reduction in systolic blood pressure compared with the online control intervention, 10 mm Hg versus 6 mm Hg, according to results from the REACH trial presented by Robert P. Nolan, PhD, on March 18 at ACC.17 in Washington, D.C.

In the double-blind randomized trial, 264 study participants (average age 57.5 years, 58 percent women, 73 percent white) were randomly assigned to electronic lifestyle modification counseling (e-counseling) or the control intervention. Study participants had an average baseline blood pressure of about 140/90 mm Hg and all received regular medical care throughout the study. About 15 percent had Stage 2 hypertension, while 83 percent of participants were taking at least one blood pressure lowering medication.

Both the e-counseling and control groups received weekly emails for four months, bi-weekly emails for the next four months, and monthly emails for the last four months of the 12-month study. The emails to the e-counseling group provided links to online multimedia and interactive tools to increase motivation and skills to begin and sustain a heart-healthy lifestyle. The emails to the control group provided links to generic information about heart-healthy living and reducing high blood pressure.

Assessments were conducted in person at study entry, four months and 12 months. The primary endpoints were changes in systolic and diastolic blood pressure and pulse pressure. After 12 months, pulse pressure was reduced by 4 mm Hg in the e-counseling group versus 1.5 mm Hg in the control group. The reduction in diastolic blood pressure differed between women and men; in women it was 6 mm Hg in both treatment groups, while in men it was reduced by 4 mm Hg with e-counseling versus 1.5 mm Hg with the control intervention. The therapeutic benefit observed in the study was not affected by the relative level of blood pressure (Stage 1 or 2) at study entry. E-counseling also improved physical activity, with a significant increase in the four-day step count, compared with a decline in the control group.

"The e-counseling intervention had an effect similar to that of adding an additional blood-pressure-lowering medication," said Nolan. "We think this lifestyle counseling intervention can complement and optimize the effectiveness of medical therapy to reduce high blood pressure."

Keywords: ACC17, ACC Annual Scientific Session, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Cognition, Counseling, Diet, Double-Blind Method, Hypertension, Intention to Treat Analysis, Lipoproteins, Self Care, Smoking Cessation

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