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WASHINGTON -- An internet-based intervention to boost adherence to lifestyle recommendations and medication among hypertensive patients improved blood pressure control and overall cardiovascular risk, a proof-of-concept trial showed.
with the e-counseling intervention compared with a 6.0 mm Hg improvement at 12 months among controls seeing more generic material on similar themes for the same amount of time (P=0.03), according to , of the University of Toronto, and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Framingham risk fell by 1.9% with the intervention compared with 0.2% in the control group at 12 months for this population at typically moderate risk (P=0.01), they reported at the American College of Cardiology (ACC) annual meeting.
The intervention also improved non-HDL cholesterol and diastolic blood pressure in men only, and pulse pressure for both sexes overall, among the 197 patients randomized to the intervention or control group.
"We suggest that the outcomes were clinically meaningful," Nolan said at the late-breaking clinical trial session.
Discussant , of University Hospitals Cleveland Medical Center, called the findings promising for this major clinical problem. "Most other methods have not worked very well at all," he said. The "impressive" blood pressure effect "approximates what happens with other interventions," he added, although cautioning that these results were in a "very select patient population" with unknown scalability.
The intervention included a series of 14 videos dealing with diet, exercise, pharmacotherapy, and smoke-free living using techniques from motivational interviewing and cognitive behavioral therapy, such as showing a discussion among patients with positive role modeling. Nolan noted that an online intervention is more widely scalable than in-person interventions.
"I love this trial," , of the Oregon Health & Science University in Portland, said as a discussant at an ACC press conference. "Diet and lifestyle sound really good, but if you have a 10-minute appointment with me, I'm not making much impact on your diet and lifestyle choices. We've tried unsuccessfully to have e-programs to impact this."
, of Brigham and Women's Hospital in Boston, agreed. "When I'm in practice and I have to move very quickly, it's hard to impart advice about lifestyle change. I find myself more and more often prescribing apps or saying buy a step counter... If this tool is available, it is something I will add to my list of things I recommend to patients."
Nolan said his group hopes to make the core program available online to everyone for free, but "before we offer it as a formal intervention population-wide, we really do need to do little more homework." The participants were self-motivated, seeking information online to express interest in participating and most were Caucasian.
While tweaks may be made to enhance its generalizability to other socioeconomic and cultural groups, they will "stay with the behavioral science that we know works here," he told ľֱ, adding that the study provides support for a scalable phase III trial.
Disclosures
Nolan disclosed no relevant relationships with industry.
Primary Source
American College of Cardiology
Nolan R, et al "e-Counseling for Self-Care Adherence Adds Therapeutic Benefit for Hypertension: The REACH Trial" ACC 2017; Abstract 404-12.