Lifestyle Educational Program Strongly Increases Compliance to Nonpharmacologic Intervention in Hypertensive Patients: A 2‐Year Follow‐Up Study

Abstract

The authors investigated the efficacy of a lifestyle educational program, organized in small group meetings, in improving the outcome of a nonpharmacologic intervention. One hundred and eighty-eight hypertensive patients with stable blood pressure (BP) levels and drug therapy in the previous 6 months were randomly divided into educational care (EC) and usual care (UC) groups. They were followed at 3-month intervals up to 2 years. In addition to the visits in an outpatient clinic, patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment. At baseline, EC and UC groups were similar for age, sex, body mass index (BMI), blood pressure (BP) levels, and pharmacologic treatment. Patients in the EC group had significantly reduced total energy, total and saturated fats, and sodium intake. Physical activity was significantly increased in the EC group as well. At the end of the 1-year follow-up, BMI (P<.001), visceral fat (P<.001), and BP (P<.001) were significantly lower in the EC group compared with the UC group. Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study. J Clin Hypertens (Greenwich). 2012;14:767-772. Ó2012 Wiley Periodicals, Inc.The association between arterial hypertension and other metabolic diseases has been frequently observed in the literature by several investigators and by ourselves in both clinical studies in the outpatient clinic and in observational studies in large population samples.1-4 Overweight status particularly seems to influence the development of hypertension but impairment in blood lipids and glucose are also involved, as seen in the metabolic syndrome.5 Accordingly, guidelines for optimal treatment of arterial hypertension indicate that nonpharmacologic intervention is the first approach in patients with low global cardiovascular risk and is associated with drug therapy in patients with moderate to high global risk. 6Despite the interest to prevent the vascular complications of hypertension, the goal of normal blood pressure (BP) levels is achieved in only <25% patients with hypertension worldwide. Reasons for this disappointing result vary, including low dosage of antihypertensive drugs, patients not taking prescribed pills, resistant hypertension, and poor compliance to prescribed nonpharmacologic measures. We have described the difficulties found by our patients in continuing a dietary approach to improve BP over a long period of time despite achieving significant improvement in BP and body weight (BW) control, associating lifestyle changes with pharmacologic treatment. The aim of the present study was to evaluate whether an educational program dedicated to nonpharmacologic measures to treat hypertension, including small group meetings with doctors and dieticians in addition to usual controls in the outpatient clinic would be useful in achieving better and long-lasting results i...

The Effect of Theory Based Nutritional Education on Fat Intake, Weight and Blood Lipids

“…Evidence from an experimental review study conducted on 104 studies showed that about three-quarters of interventions have been successful in total fat and saturated fat reduction ( 37 ). Fat intake reduction in the present study is consistent with the results reported by other studies ( 38 – 41 ). Also, in Epstein’s study (2012), total and saturated fat significantly reduced after nutritional intervention was based on DASH ( 42 ).…”

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

“…73 An additional RCT comparing group care with usual care in adults with hypertension was identified. 93 However, this study was excluded from our review because group care involved small group educational meetings with physicians and dietitians but no apparent clinical input. According to the CADTH rapid review, which had a broader inclusion of 'group care', 52 this RCT 93 reported on fasting blood glucose, blood pressure, lipids, weight and BMI.…”

“…93 However, this study was excluded from our review because group care involved small group educational meetings with physicians and dietitians but no apparent clinical input. According to the CADTH rapid review, which had a broader inclusion of 'group care', 52 this RCT 93 reported on fasting blood glucose, blood pressure, lipids, weight and BMI. The study did demonstrate that, compared with control, group care resulted in statistically significant improvement in blood pressure, weight and BMI, but more details of the intervention are required to establish its eligibility.…”

Outcome of a public consultation on the Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for sodium (intermediate draft) and related protocol

“…Comment received 28. It was noted that Savilahti and Saarinen (2007) was missing from the reference list.…”