Effectiveness of Lifestyle and Drug Intervention on Hypertensive Patients: a Randomized Community Intervention Trial in
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Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, People’s Republic of China; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; 3Department of Chronic Disease and Prevention, Center for Disease Control and Prevention of Haian, Nantong, People’s Republic of China; 4Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
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BACKGROUND: Strict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow. OBJECTIVE: To evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients. DESIGN: Randomized community intervention trial. PARTICIPANTS: The control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China. MAIN MEASURES: Data on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention. KEY RESULTS: BP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and
Jing Xiao, Wen-Long Ren and Yuan-Yuan Liang contributed equally to this work. Zuo-Feng Zhang is a co-senior author. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05601-7) contains supplementary material, which is available to authorized users. Received January 21, 2019 Revised July 31, 2019 Accepted November 7, 2019
biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001). CONCLUSION: The addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone. KEY WORDS: hypertension; lifestyle intervention; effectiveness; blood pressure control rate. J Gen Intern Med DOI: 10.1007/s11606-019-05601-7 © Society of General Internal Med
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