ACC.17: Electronic counseling intervention may benefit patients with hypertension

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 - Robert P. Nolan, PhD

Patients with hypertension who received an electronic counseling intervention had a 10.1 mmHg reduction in systolic blood pressure after a year compared with a six mmHg reduction for a control group, according to a randomized, double-blind controlled trial in Canada.

The differences were statistically significant, according to the researchers. The results were adjusted for baseline systolic blood pressure, sex and antihypertensive medications.

The researchers noted that a 10 mmHg reduction in systolic blood pressure is associated with a 20 percent risk reduction in cardiovascular disease events, a 17 percent risk reduction in coronary heart disease, a 27 percent risk reduction in stroke and a 13 percent risk reduction in all-cause mortality.

Lead researcher Robert P. Nolan, PhD, of the University of Toronto, presented the findings of the REACH trial in a late-breaking clinical trial session at the American College of Cardiology (ACC) scientific session on March 18 in Washington, D.C.

“What this trial told us was that e-counseling did help to improve the benefit of usual care for hypertension,” Nolan said during a press conference. “The outcomes were clinically meaningful in reducing the risk for a number of outcomes—cardiovascular disease, heart disease, stroke and all-cause mortality. We hope that our findings will support a population-based e-counseling trial.”

The study enrolled patients with stage 1 or 2 hypertension, which the researchers defined as systolic blood pressure between 140 mmHg and 180 mmHg and diastolic blood pressure between 90 mmHg and 110 mmHg. The patients enrolled through the Heart and Stroke Association of Canada website.

Nolan said the REACH trial was the first double-blind randomized controlled study examining electronic counseling for hypertension.

A total of 264 patients were randomized in a 1:1 ratio to electronic counseling group or the control group. All patients received usual care, as well. They were assessed at four, eight and 12 months.

At baseline, the groups were well balanced. The mean age was 57.5 years old, and 58 percent of patients were women.

Each group received emails weekly for four months, every other week for the next four months and monthly for the final four months. Patients in the electronic counseling group received links to online tools to track their diet and level of physical activity. Nolan said during a press conference that they also had access to 14 videos that included summaries of self-help guidelines to initiate and sustain therapeutic lifestyle changes and vignettes showing peoples’ experiences to sustain their lifestyle changes. In addition, they had peer discussions that provided positive role modeling and received virtual support for sustained lifestyle changes.

Meanwhile, Nolan noted that the control group received information and education on accurately monitoring blood pressure, initiating therapeutic lifestyle changes and use tools to discuss their results with physicians.

At four months, the electronic counseling group had a mean 8.2 mmHg reduction in systolic blood pressure, while the control group had a mean decrease of 5.6 mmHg. At 12 months, the mean reduction was 10.1 mmHg and six mmHg.

After 12 months, the electronic counseling group had a mean 4.3 mmHg reduction in pulse pressure, while the control group had a mean decrease of 1.5 mmHg. That difference was statistically significant. Meanwhile, at one year, the Framingham risk score decreased 1.9 percent in the electronic counseling group and increased 0.2 percent in the control group.

Among females, the diastolic blood pressure decreased six mmHg in each group after a year. Among males, the diastolic blood pressure decreased 4.1 mmHg in the electronic counseling group and declined 0.3 mmHg in the control group.

In addition, among females, the non-high-density lipoprotein (non-HDL) cholesterol level increased 4.6 mg/dL in the electronic counseling group and decreased 0.7 mg/dL in the control group. Among males, the non-HDL cholesterol level decreased 4.3 mg/dL in the electronic counseling group and increased 11.3 mg/dL in the control group.