EFFECTIVENESS OF LIFESTYLE MODIFICATION PROGRAMS FOR CONTROL OF BLOOD PRESSURE: A NON-RANDOMIZED CONTROLLED TRIAL IN KOMATSU, JAPAN

Abstract

Purpose A non-randomized controlled trial was conducted to evaluate the effectiveness of three lifestyle modification programs to reduce blood pressure: individual counseling only; counseling using group dynamics; and individual support using mail.
Methods We enrolled men and women ages 20-69 with a systolic blood pressure (SBP) of 130-159 mmHg and/or a diastolic blood pressure of 85-99 mmHg (high-normal or mild hypertension). Participants were assigned to one of 4 groups: individual counseling (n=134); group counseling (n=79); mailing support (n=127); and controls (with usual care) (n=178). The three intervention programs included behavioral support for each person's lifestyle problems once a month for 6 months. Sex and age adjusted net blood pressure change (and 95% confidence intervals [CIs]) compared with the control group was calculated for each of the intervention groups.
Results Net SBP change was the largest for the group counseling group: sex and age adjusted net SBP change was −6.5 mmHg (95%CI: −10.0, −3.0). Net SBP change for the mailing support group was also significant (−4.3 mmHg [95%CI: −7.3, −1.3]). Net SBP change for the individual counseling group was −2.5 mmHg (95%CI: −5.5, 0.5). Looking at the results separately by sex, net SBP reduction was also largest in women of the group counseling group, whereas improvement in men was similar among 3 groups (approximately 4 mmHg). Body weights were reduced by about 1 kg in all 3 groups.
Conclusions Lifestyle modification programs using group dynamics or using individual support by mail, in addition to individual behavioral support, appear to be effective for blood pressure reduction. Group counseling may be more effective in women.