Educational program lowers BP, reduces cardiac risk in hypertensive patients
MedWire News: A structured educational program could improve management of blood pressure (BP) and reduce the risk for cardiovascular disease (CVD), Austrian researchers say.
Broad implementation of such a program in the management of hypertension at the primary care level is justified, write Sabine Perl (Medical University of Graz) and co-authors in the Journal of Hypertension.
The herz.leben (in English, heart.life) project has so far followed-up 744 patients (54.0% women) with a mean age of 62.8 years and body mass index (BMI) of 29.5 kg/m2 for 1 year.
Patients were eligible for the program if their office BP was uncontrolled despite following an optimal antihypertensive drug therapy regime. Uncontrolled BP was defined as a repeat measurement of >160/95 mmHg on two separate occasions, or >140/90 mmHg in addition to having an elevated cardiovascular risk profile >15% according to the New Zealand Risk Score (NZRS).
NZRS calculates the 5-year risk for a fatal or nonatal cardiovascular event using gender, age, diabetes, smoking status, BP, and cholesterol.
Patients maintained their antihypertensive drug regime throughout the study. Their BP was measured at four stages during the program, and a physician adapted their therapy if necessary.
The program was led by general practitioners, hypertension nurses, and outpatient staff from local hospitals and consisted of four modules. The first module informed patients about the causes, prevalence, and consequences of hypertension and showed them how to measure their BP at home.
The second module showed patients how to choose food products low in fat and salt.
The third module highlighted the importance of physical activity. Each patient was taught how to increase their levels of physical activity and it was recommended that all patients exercise for at least half an hour three times a week.
In the final module a physician discussed the basics of antihypertensive therapy and hypertensive emergencies. The main topics of each module were also revised.
The findings revealed that mean systolic BP significantly declined from 156.1 mmHg at baseline to 139.2 mmHg 1 year after completing the program. Diastolic BP also decreased significantly, from 88.9 mmHg to 82.1 mmHg.
The mean weight of the patients declined after 1 year, from 82.5 kg to 81.9 kg.
Further analysis showed that there were also significant reductions in BMI, (from 29.3 to 29.1 kg/m2), total cholesterol (from 207.0 to 199.9 mg/dl), and low-density lipoprotein (from 122.3 to 116.2 mg/dl).
The mean NZRS improved significantly, from 17.3 to 13.8.
"Further trials are needed to evaluate the cost-effectiveness of educational and disease management programs for hypertensive management," conclude Perl and team.
By Piriya Mahendra