The effect of a lifestyle modification adherence tool on risk factors in patients with chronic hypertension compared to usual management
Date
2012-07-12
Authors
Webber, Janine
Journal Title
Journal ISSN
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Abstract
Background
Poor adherence to lifestyle interventions and medication-taking poses a problem
universally. However, there are interventions to help patients adhere to treatment
regimens and in turn, lower the risk of cardiovascular disease by decreasing blood
pressure. These interventions need to be investigated further. Change in risk factors as a
result of a lifestyle modification adherence tool in patients with chronic hypertension is
not clear and will be further investigated in this study.
Aim
To determine the effect of a lifestyle modification adherence tool in patients with chronic
hypertension and compare this with usual management.
Objectives
1. To compare the changes in:
· Blood pressure
· Waist-hip ratio
· Weight and body mass index
· Blood glucose, cholesterol, triglycerides, HDL and LDL levels
· Exercise Capacity
between two experimental and one control group at baseline and after a six month
intervention using a lifestyle modification tool
2. To determine the sustainability of the intervention three months after the intervention
is concluded.
Design
The study design was a quantitative, longitudinal randomized control trial consisting of
two experimental and one control group.
Method
Ninety subjects at the hypertension clinic at Helen Joseph Hospital were sampled
consecutively and then randomized using computer generated randomization and
concealed allocation.
The study consisted of three groups, two experimental and one control group.
All three groups underwent the usual treatment in the Hypertension Clinic. Experimental
group one (EG1) received the Lifestyle Modification Adherence Tool (LMAT) as well as
a once-a-month telephone call from the research assistant. Experimental group two
(EG2) received only a once-a-month telephone call from the research assistant. The
control group (CG) received the standard treatment at the clinic.
The significance of the study was set at p=0.05. A Students t-test (independent) was used
to compare variables between groups at baseline. The Pearsons Chi Square test was used
to compare and analyze non parametric data at baseline.
Change in blood pressure, waist-hip ratio, weight and body mass index, glucose levels
and exercise capacity between control and intervention groups was established using an
ANCOVA.
Pairwise t-tests were used to compare p-values between groups one and two; one and
three and; two and three.
Results
No reductions in weight and body mass index (BMI) were observed. Significant
differences in EG1 for waist/hip ratios were noted compared with the EG2 (p=0.04) and
CG (p=0.04) between month 0 and month 6. Blood pressure reductions were greater in
EG1 compared with EG2 and the CG at six months but greater drops in blood pressure
were noted in EG2 compared with EG1 and the CG between six and nine months.
However, these differences were not significant. Significant reductions were observed in
blood glucose levels in the EG1 compared with EG2 group between month 6 and month
9 (p=0.05). There were also significant reductions in the EG2 in triglycerides and low
density lipoprotein (LDL) between month 0 and month 6 compared with the CG (p= 0.04
and p= 0.03 consecutively) and significant LDL reductions in both EG1 and EG2
between month 6 and month 9 compared with the CG (p= 0.02 for both comparisons).
Walking distances improved minimally in both EG1 and EG2 but these changes were not
significant.
Conclusion
Although not all results were significant, diary and telephone interventions and telephone
only intervention to improve adherence did show a positive trend towards improvements
in risk factors of patients with chronic hypertension.
Description
M.Sc. (Physiotherapy), Faculty of Health Sciences, University of the Witwatersrand, 2011