title: Therapeutic benefit of internet-based lifestyle counselling for hypertension.
abstract: BACKGROUND
  Preventive electronic (e)-counselling has been shown to reduce cardiovascular risk factors. However, heterogeneity in outcomes is commonly reported due to differences in e-protocols. We incorporated key features of an established behavioural therapy, motivational interviewing, to help standardize e-counselling in order to reduce blood pressure in patients with hypertension.
  
  
  METHODS
  Subjects (n = 387, mean age = 56 years, 59% female, 72% taking ≥ 1 antihypertensive drug) were diagnosed with stage 1 or 2 hypertension. Subjects were randomized to a 4-month protocol of e-counselling (beta version of the "Blood Pressure Action Plan", Heart and Stroke Foundation of Canada) vs waitlist control (general e-information on heart-healthy living). Outcomes were systolic, diastolic, and pulse pressures, and total lipoprotein cholesterol after treatment.
  
  
  RESULTS
  Intention to treat analysis did not find a significant group difference in outcomes due to contamination across the 2 arms of this trial. However, per protocol analysis indicated that subjects receiving ≥ 8 e-counselling messages (a priori therapeutic dose) vs 0 e-counselling messages (control) demonstrated greater reduction in systolic blood pressure (mean, -8.9 mm Hg; 95% confidence interval [CI], -11.5 to -6.4 vs -5.0 mm Hg; 95% CI, -6.7 to -3.3, P = 0.03), pulse pressure (-6.1 mm Hg; 95% CI, -8.1 to -4.1 vs -3.1 mm Hg; 95% CI, -4.3 to -1.8, P = 0.02) and total cholesterol (-0.24 mmol/L; 95% CI, -0.43 to -0.06 vs 0.05 mmol/L; 95% CI, -0.06 to 0.16, P = 0.03), but not diastolic blood pressure.
  
  
  CONCLUSIONS
  These findings support the merit of evaluating whether e-counselling can improve blood pressure control and reduce cardiovascular risk over the long-term.
authors.affiliation: Behavioural Cardiology Research Unit, University Health Network, Toronto, Ontario, Canada. rnolan@uhnres.utoronto.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Nolan
authors.forename: Sam
authors.initials: S
authors.lastname: Liu
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Shoemaker
authors.forename: Vladimir
authors.initials: V
authors.lastname: Hachinski
authors.forename: Hazel
authors.initials: H
authors.lastname: Lynn
authors.forename: David J
authors.initials: DJ
authors.lastname: Mikulis
authors.forename: Richard A
authors.initials: RA
authors.lastname: Wennberg
authors.forename: Margaret
authors.initials: M
authors.lastname: Moy Lum-Kwong
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zbib
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods; D001795:Blood Pressure Determination / Q000379:methods; D002170:Canada; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003376:Counseling / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D020407:Internet / Q000706:statistics & numerical data*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000959:Antihypertensive Agents