Does E-counseling For Self-care Adherence Improve Hypertension?

WASHINGTON, DC — A multi-center, double-blind, randomized trial demonstrated  that Internet-based e-Counseling improved hypertension and cardiovascular disease (CVD) risk in adults with high blood pressure.¹

Findings from the REACH (Reducing Risk with E-based support for Adherence to Lifestyle Change in Hypertension; Clinicaltrials.gov identifier: NCT01541540) trial were reported at the 66th Annual Scientific Session & Expo of the American College of Cardiology (ACC).

Lifestyle counseling combining diet and exercise has been found to improve cardiovascular outcomes, including blood pressure, in people with CVD risk factors.² Although previous research has shown e-Counseling to be similarly effective to conventional lifestyle programs in reducing blood pressure, those studies varied in terms of the technology used and lacked specific models of behavior counseling.³

The REACH trial examined whether an e-Counseling intervention drawing on evidence-based motivational and cognitive behavior therapy would improve blood pressure and CVD risk in patients with stage 1 or stage 2 hypertension. In addition to usual care, participants were assigned to either a control group that received e-education regarding self-care (n=131), or to e-Counseling treatment (n=133), which focused on self-care pertaining to diet, physical activity, smoking cessation, and medication adherence. Blood pressure was assessed at baseline and at 4 and 12 months.  

At the end of 12-months, participants from the e-Counseling group had lower systolic blood pressure (-10.1 mm Hg (95% CI, -13 to -8) compared with the e-education group (-6.0 mmHg (95% CI, -9 to -3), as well as lower pulse pressure (e-Counseling: -4.3 mm Hg [95% CI, -7 to -2]; control: -1.5 mm Hg [95% CI, -4 to 1] and Framingham 10-year cardiovascular disease risk (E-Counseling: -1.9% [95% CI, -3 to -0.6]; control: 0.2% [95% CI, -1 to 2]. Men who received e-Counseling demonstrated lower diastolic blood pressure and non-high-density lipoprotein cholesterol compared with controls.

“The electronic counseling (e-Counseling) intervention had an effect similar to that of adding an additional blood-pressure-lowering medication,” lead author Robert P. Nolan, PhD, a senior scientist at the Peter Munk Cardiac Centre, University Health Network, and associate professor at the University of Toronto, noted in an ACC press release regarding the study.4 “We believe this dynamic way of engaging patients can be a very powerful tool to promote behavior change,” he said.  

References

1. Nolan R’ on behalf of the REACH Investigators. E-counseling for self-care adherence adds therapeutic benefit for hypertension: the REACH Trial. Presented at: the 66^th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.
2. Lin JS, O’Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral counseling to promote a healthy lifestyle for cardiovascular disease prevention in persons with cardiovascular risk factors: an updated systematic evidence review for the US Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014. Report No.: 13-05179-EF-1
3. Burke LE, Ma J, Azar KM, Bennett GG, et al. Current science on consumer use of mobile health for cardiovascular disease prevention: a Scientific Statement from the American Heart Association. Circulation. 2015;132(12):1157-1213. doi:10.1161/CIR.0000000000000232
4. Lifestyle intervention leads to 10-point drop in systolic blood pressure [press release]. Washington, DC: American College of Cardiology; March 18, 2017.

This article originally appeared on The Cardiology Advisor