Non-pharmacological treatment of hypertension in primary health care: A comparative clinical trial of two education strategies in health and nutrition

Abstract

BackgroundPoor adherence to non-pharmacological treatment of hypertension represents a serious challenge for public health policies in several countries. This study was conducted to compare two intervention strategies regarding the adherence of adult women to dietary changes recommended for the treatment of hypertension in a community covered by Primary Health Care Unit.MethodsThis study is a randomized controlled trial of a sample composed of 28 women with hypertension enrolled in the Primary Health Care Unit located in the urban area of southeastern Brazil. The participants were already undergoing treatment for hypertension but devoid of nutritional care; and were divided into two groups, each composed of 14 individuals, who received interventions that consisted of two different strategies of nutritional guidance: monthly health education workshops alone (Group 1) and combined with family orientation through home visits (Group 2). Adherence to nutritional guidelines was evaluated by dietary, anthropometric, clinical and serum biochemical parameters, measured before and after the interventions. Knowledge on control and risk of hypertension was also investigated. The study lasted five months.ResultsMean age was 55.6 (± 2.8) and 50.7 (± 6.5) in the groups 1 and 2, respectively. The home orientation strategy promoted greater adherence to dietary changes, leading to a statistically significant improvement in the clinical, anthropometric, biochemical and dietary parameters. The group 2 reduced the consumption of risk foods (p = 0.01), oil (p = 0.002) and sugar (p = 0.02), and decreased body mass index (-0.7 kg/m2; p = 0.01); waist circumference (-4.2 cm; p = 0.001), systolic blood pressure (-13 mm HG; p = 0.004) and glycemia (-18.9 mg/dl; p = 0. 01). In group 1 only waist circumference (-2 cm; p = 0.01) changed significantly.ConclusionNutritional orientations at the household level were more effective with regard to the adherence of individuals to non-pharmacological treatment of hypertension, regarding the reduction of clinical and behavioral risk parameters.

Adherence to non-pharmacological treatment: Analysis of the impact of three health educational and nutritional strategies in hypertensive patients

“…The socioeconomic characteristics of the study population were similar to those of other samples, where most participants in educational activities provided by Primary Health Care services are female older adults, have low education level and income, and are retired or pensioners 8,19 . In face of the current demographic, epidemiological, and nutritional transitions, and the increase in life expectancy and prevalence of NCD, the health care provided by Primary Health Care needs to be reassessed, prioritizing actions that meet individuals' needs and that help them to adopt healthy habits 23 .…”

“…It is consensus that structured health education programs for hypertension patients improve their health conditions, including risk factors and adherence to the recommended treatment 7,18 . Studies that analyzed the effectiveness of educational interventions in hypertension individuals found that education programs improved their behavior and adherence to non-pharmacological treatment considerably 8,19,20 . However, the reluctance of patients and health professionals to believe in the effectiveness of health education actions for a number of reasons is also discussed, such as: the method used, which is often prescriptive, normative, and out of context with respect to the population's reality; the trumping of professional knowledge over popular knowledge and of clinical practice over promotive and preventive actions; the tendency of health actions to be fragmented, disarticulated, and not multidisciplinary; and the population's little interest in changing life habits [19][20][21][22] .…”

“…The lowest acceptable workshop attendance (n=8) was given by the median attendance and the results obtained by Ribeiro et al 8 , who found that five months of intervention were not enough for participants to incorporate long-term changes in health and eating behaviors. Based on this criterion, individuals were allocated to groups 1 or 3 after the intervention.…”

“…Education reduces blood pressure, body weight, and waist circumference; and improves lipid profile, blood glucose, habitual food intake, and knowledge about the health-disease-care process 8,10 .…”

“…Behavioral risk factors constitute the main targets of hypertension prevention and treatment because when corrected, they effectively reduce blood pressure and its complications. The main non-pharmacological recommendations to prevent primary hypertension are: losing weight, reducing salt and alcohol intakes, quitting smoking, practicing physical activity regularly, and eating healthy 1,[6][7][8] .…”