The implementation of e-counseling, in addition to traditional medical therapy, improved systolic blood pressure, pulse pressure, and cardiovascular disease (CVD) risk reduction in the REACH (Reducing Risk with E-based support for Adherence to Lifestyle Change in Hypertension) trial. Results of the trial were published in the American Heart Association’s journal Circulation.
“Conventional (clinic-based) lifestyle programs are efficacious in modifying self-care behaviors (exercise, diet, medication adherence, and smoke-free living) but at significant cost for service delivery,” wrote Robert Nolan, PhD, of the Toronto General Research Institute, and colleagues. “Internet-based programs of e-counseling for CVD risk reduction have comparable efficacy to conventional programs, but trials have yielded heterogenous treatment effects.”
Nolan and colleagues sought to determine if e-counseling with traditional motivational and cognitive behavior therapy would improve blood pressure and CVD risk.
The double-blind randomized trial included 264 hypertensive individuals exhibiting Stage 1 or 2 hypertension with a baseline blood pressure reading of more than 130/85 mmHg. Approximately 83 percent of the cohort were taking at least one blood pressure-lowering medication.
All of the participants received traditional medical therapy—and were also randomly assigned to e-counseling or a control group that received electronic information regarding blood pressure management.
Both groups received weekly emails for months 1 to 4, bi-weekly emails for months 5 to 8 and monthly emails for months 9 to 12. Emails for the e-counseling group provided links to online multimedia and interactive tools to increase motivation and provide them with the skills to start a heart-healthy lifestyle. The control group received generic information regarding heart-healthy living and reducing high blood pressure.
Blood pressure was assessed at 4 and 12 months. At one-year, the researchers found:
- The e-Counseling group decreased their systolic blood pressure by 10 mmHg, compared to a decrease of 6 mmHg in the control group.
- The e-Counseling group decreased their pulse pressure by 4 mmHg, compared to a decrease of only 1 mmHg in the control group.
- Men in the e-Counseling group decreased their diastolic blood pressure by 12 mmHg, compared to a decrease of 4 mmHg in the control group.
- There was no difference in diastolic blood pressure in the women in both groups.
“Health information seeking is the third most popular online activity, and it is practiced by 72 percent of internet users,” Nolan et al. wrote. “However, survey data indicates that 91 percent of health information seekers with a chronic health condition express the need for guidance to locate and navigate websites that can support their effort to improve self-care knowledge or skill. This suggests that there is a fundamental need in e-health to develop protocols that are clinically organized to guide patients for a long-term interval in sustaining self-care behavior.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.