Participants in an online behavioural 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 Dr Robert P Nolan at the American College of Cardiology 2017 scientific meeting in Washington DC.
In the double-blind randomised trial, 264 study participants (average age 57.5 years, 58% women, 73% white) were randomly assigned to electronic lifestyle modification counselling (e-counselling) 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% had Stage 2 hypertension, while 83% of participants were taking at least one blood pressure lowering medication.
Both the e-counselling 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-counselling 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 4mm Hg in the e-counselling group versus 1.5mm Hg in the control group. The reduction in diastolic blood pressure differed between women and men; in women it was 6mm Hg in both treatment groups, while in men it was reduced by 4mm Hg with e-counselling versus 1.5mm 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-counselling also improved physical activity, with a significant increase in the four-day step count, compared with a decline in the control group.
"The e-counselling intervention had an effect similar to that of adding an additional blood-pressure-lowering medication," said Nolan. "We think this lifestyle counselling intervention can complement and optimise the effectiveness of medical therapy to reduce high blood pressure."
[link url="https://www.acc.org/latest-in-cardiology/articles/2017/03/13/17/44/sat-8am-reach-e-counseling-for-self-care-adherence-adds-therapeutic-benefit-for-htn-acc-2017?w_nav=LC"]American College of Cardiology material[/link]
[link url="http://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_492225.pdf"]ACC17 Scientific Sessions abstract book[/link]