Comparison of the effect of structured lifestyle modification versus verbal advice only on blood pressure control among pre-hypertensive adults in a tertiary hospital in north central Nigeria

Abstract

Background: Results from several clinical trials show that comprehensive behavioural intervention programs improve lifestyle behaviors and lower blood pressure. The study compared the effect of structured lifestyle modification versus verbal advice only on blood pressure control among prehypertensive adults presenting in the GOPD of JUTH.

Study Design/Setting: The study was a randomized study involving prehypertensive adults aged 20 years and above presenting in GOPD of JUTH.

Methods: Participants were consecutively selected and randomized into two groups, a structured lifestyle modification group (Group A) and a verbal advice only group (Group B). Group A was offered a structured lifestyle modification counselling while routine verbal advice only was offered to group B. Data were collected about patients' socio-demographic, medical and lifestyle habits that included dietary and exercise history. Physical examination included blood pressure measurement. Participants were followed up monthly for twelve weeks during which blood pressure measurement was routinely carried out and changes in their lifestyle habits reported. The primary outcome was reduction in BP. The means at 95% confidence intervals of the blood pressure values of the two groups were determined using paired t-test analysis. Data were analyzed on an intention to treat basis. A p-value of <0.05 was considered significant in all analyses.

Results: The mean systolic blood pressure reduction in group A after 12 weeks was 3.61 mmHg (1.52, 5.26; 95% CI) while the mean diastolic pressure reduction after the same duration was 0.44 (-2.25, 1.97, 95%). Paired t-test analysis revealed a statistically significant difference in the mean reduction in SBP at the end of the study,{t(31)2.23, p=0.02}. The mean reduction in diastolic blood pressure on completing the study was however not significant, {t(31)0.9, p=0.17}.

The mean systolic blood pressure reduction in group B after 12 weeks was 2.75mmHg (-1.23, 5.23, 95% CI) while the mean diastolic pressure reduction after the same period was 0.38 (-2.26, 1.98, 95% CI). Paired t-test analysis revealed no statistical difference in the mean reduction in SBP and DBP at the end of the study - {t(29)1.39, p=0.062}versus {t(29)0.92, p=0.14}

Conclusion: Findings from the study show that individuals with pre-hypertension can make and sustain, during a period of 12 weeks, structured multiple lifestyle modifications which can significantly control or reduce systolic blood pressure. There is therefore a need for improved lifestyle intervention programs, including those appropriate for delivery in the clinical setting, that enable individuals with or at risk for hypertension to adopt long-term healthier lifestyles.