title: A HEALth Promotion and STRESS Management Program (HEAL-STRESS study) for prehypertensive and hypertensive patients: a quasi-experimental study in Greece.
abstract: Current hypertension guidelines advocate strategies encouraging healthy lifestyle behaviours. So far, there is a paucity of studies for the efficacy of such multifaceted programmes. The aim of this study is to investigate the efficacy of an 8-week health-promotion programme for lowering blood pressure (BP) in prehypertensive and hypertensive patients in the community. This was a quasi-experimental study using wait-list controls of 548 patients. The intervention group was administered with an 8-week health-promotion intervention. Measurements included home BP, smoking, body mass index (BMI), perceived stress, depression, anxiety and Health Locus of Control. After adjusting for confounders, the intervention group had a significant reduction in both systolic BP (SBP; mean -2.62 mm Hg, 95% confidence interval (CI): -1.29 to -3.96) and diastolic BP (DBP; mean -1.0, 95% CI: -0.93 to -1.9) compared with controls. In all, 14.9% of patients in the intervention group had >10 mm Hg reduction in SBP vs 4.4% in the control group (P<0.001, numbers needed to treat (NNT)=10). With regards to DBP, 21.7% of patients in the intervention group had >5 mm Hg reduction vs 12.5% in the control group (P=0.01, NNT=11). In terms of effect size, moderate-to-large improvements of BMI, perceived stress, anxiety, depression, external and chance Health Locus of Control were recorded. Changes in SBP and DBP were attributed to BMI and depressive symptom reductions, respectively. Comprehensive non-pharmaceutical programmes for BP management are strongly encouraged. Their long-term benefits on cardiovascular morbidity and mortality remain to be established by future research.
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Darviri
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: A K
authors.initials: AK
authors.lastname: Artemiadis
authors.affiliation: Hypertension Center and Cardiovascular Research Laboratory, First Department of Propaedeutic Medicine, 'Laiko' Hospital, Medical School, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Protogerou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Soldatos
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Kranioutou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Vasdekis
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: L
authors.initials: L
authors.lastname: Varvogli
authors.affiliation: Hypertension Center and Cardiovascular Research Laboratory, First Department of Propaedeutic Medicine, 'Laiko' Hospital, Medical School, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Nasothimiou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Vasilopoulou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Karantzi
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Linardatou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Michou
authors.affiliation: School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: G P
authors.initials: GP
authors.lastname: Chrousos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006115:Greece; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D000070497:Healthy Lifestyle; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods*; D013315:Stress, Psychological / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult