Therapeutic Benefit of Internet-Based Lifestyle Counselling for Hypertension
| Autor: | Ahmad Zbib, J. Kevin Shoemaker, Richard Wennberg, David J. Mikulis, Margaret Moy Lum-Kwong, Sam Liu, Vladimir Hachinski, Robert P. Nolan, Hazel Lynn |
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| Rok vydání: | 2012 |
| Předmět: |
Counseling
Male Canada medicine.medical_specialty medicine.drug_class Diastole Risk Assessment Severity of Illness Index law.invention Randomized controlled trial Behavior Therapy Reference Values law Internal medicine medicine Humans Single-Blind Method Watchful Waiting Antihypertensive drug Life Style Stroke Antihypertensive Agents Aged Internet Intention-to-treat analysis business.industry Blood Pressure Determination Middle Aged medicine.disease Confidence interval Pulse pressure Treatment Outcome Blood pressure Cardiovascular Diseases Hypertension Multivariate Analysis Cardiology Physical therapy Female Cardiology and Cardiovascular Medicine business Attitude to Health Follow-Up Studies |
| Zdroj: | Canadian Journal of Cardiology. 28:390-396 |
| ISSN: | 0828-282X |
| DOI: | 10.1016/j.cjca.2012.02.012 |
| Popis: | Background Preventive electronic (e)-counselling has been shown to reduce cardiovascular risk factors. However, heterogeneity in outcomes is commonly reported due to differences in e-protocols. We incorporated key features of an established behavioural therapy, motivational interviewing, to help standardize e-counselling in order to reduce blood pressure in patients with hypertension. Methods Subjects (n = 387, mean age=56 years, 59% female, 72% taking ≥ 1 antihypertensive drug) were diagnosed with stage 1 or 2 hypertension. Subjects were randomized to a 4-month protocol of e-counselling (beta version of the "Blood Pressure Action Plan", Heart and Stroke Foundation of Canada) vs waitlist control (general e-information on heart-healthy living). Outcomes were systolic, diastolic, and pulse pressures, and total lipoprotein cholesterol after treatment. Results Intention to treat analysis did not find a significant group difference in outcomes due to contamination across the 2 arms of this trial. However, per protocol analysis indicated that subjects receiving ≥ 8 e-counselling messages (a priori therapeutic dose) vs 0 e-counselling messages (control) demonstrated greater reduction in systolic blood pressure (mean, −8.9 mm Hg; 95% confidence interval [CI], −11.5 to −6.4 vs −5.0 mm Hg; 95% CI, −6.7 to −3.3, P = 0.03), pulse pressure (−6.1 mm Hg; 95% CI, −8.1 to −4.1 vs −3.1 mm Hg; 95% CI, −4.3 to −1.8, P = 0.02) and total cholesterol (−0.24 mmol/L; 95% CI, −0.43 to −0.06 vs 0.05 mmol/L; 95% CI, −0.06 to 0.16, P = 0.03), but not diastolic blood pressure. Conclusions These findings support the merit of evaluating whether e-counselling can improve blood pressure control and reduce cardiovascular risk over the long-term. |
| Databáze: | OpenAIRE |
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