Telehealth versus self-directed lifestyle intervention to promote healthy blood pressure: a protocol for a randomised controlled trial

Mohamed Taher, Christina Yule, Heather Bonaparte, Sara Kwiecien, Charlotte Collins, Allison Naylor, S P Juraschek, Lisa Bailey-Davis, Alex R Chang, Mohamed Taher, Christina Yule, Heather Bonaparte, Sara Kwiecien, Charlotte Collins, Allison Naylor, S P Juraschek, Lisa Bailey-Davis, Alex R Chang

Abstract

Introduction: Weight loss, consumption of a Dietary Approaches to Stop Hypertension dietary pattern, reduced sodium intake and increased physical activity have been shown to lower blood pressure (BP). Use of web-based tools and telehealth to deliver lifestyle counselling could be potentially scalable solutions to improve BP through behavioural modification though limited data exists to support these approaches in clinical practice.

Methods and analysis: This randomised controlled trial will compare the efficacy of a telehealth versus self-directed lifestyle intervention in lowering 24-hour SBP in patients with overweight/obesity (body mass index ≥25 kg/m2) and 24-hour SBP 120-160 mm Hg. All participants receive personalised recommendations to improve dietary quality based on a web-based Food Frequency Questionnaire, access to an online comprehensive weight management programme and a smartphone dietary app. The telehealth arm additionally includes weekly calls with registered dietitian nutritionists who use motivational interviewing. The primary outcome is change from baseline to 12 weeks in 24-hour SBP. Secondary outcomes include changes from baseline in 24-hour diastolic BP, daytime SBP, nighttime SP, daytime diastolic BP, nighttime diastolic BP, total Healthy Eating Index-2015 score, weight, waist circumference and physical activity. Other prespecified outcomes will include change in individual components of the Healthy Eating Index-2015 score, and satisfaction with the Healthy BP research study measured on a 5-point Likert scale.

Ethics and dissemination: The study has been approved by the Geisinger Institutional Review Board. Results will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number: NCT03700710.

Keywords: cardiology; clinical trials; hypertension; nephrology; nutrition & dietetics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study flow. BP, blood pressure; SBP, systolic blood pressure.

References

    1. Whelton PK, Carey RM, Aronow WS. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American heart association Task force on clinical practice guidelines. Hypertension 2017.
    1. Virani SS, Alonso A, Benjamin EJ, et al. . Heart disease and stroke Statistics-2020 update: a report from the American heart association. Circulation 2020;141:e139–596. 10.1161/CIR.0000000000000757
    1. Sacks FM, Svetkey LP, Vollmer WM, et al. . Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3–10. 10.1056/NEJM200101043440101
    1. Appel LJ, Champagne CM, Harsha DW, et al. . Effects of comprehensive lifestyle modification on blood pressure control: main results of the premier clinical trial. JAMA 2003;289:2083–93. 10.1001/jama.289.16.2083
    1. Tuomilehto J, Jousilahti P, Rastenyte D, et al. . Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet 2001;357:848–51. 10.1016/S0140-6736(00)04199-4
    1. Muntner P, Carey RM, Gidding S, et al. . Potential U.S. population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol 2018;71:109–18. 10.1016/j.jacc.2017.10.073
    1. Berman AH, Kolaas K, Petersén E, et al. . Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care. BMC Fam Pract 2018;19:139. 10.1186/s12875-018-0829-z
    1. Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, et al. . Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One 2014;9:e89554. 10.1371/journal.pone.0089554
    1. Villinger K, Wahl DR, Boeing H, et al. . The effectiveness of app-based mobile interventions on nutrition behaviours and nutrition-related health outcomes: a systematic review and meta-analysis. Obes Rev 2019;20:1465–84. 10.1111/obr.12903
    1. Appel LJ, Clark JM, Yeh H-C, et al. . Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011;365:1959–68. 10.1056/NEJMoa1108660
    1. Thomas JG, Bond DS, Raynor HA, et al. . Comparison of smartphone-based behavioral obesity treatment with gold standard group treatment and control: a randomized trial. Obesity 2019;27:572–80. 10.1002/oby.22410
    1. Tucker KL, Sheppard JP, Stevens R, et al. . Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med 2017;14:e1002389. 10.1371/journal.pmed.1002389
    1. Omboni S, McManus RJ, Bosworth HB, et al. . Evidence and recommendations on the use of telemedicine for the management of arterial hypertension: an international expert position paper. Hypertension 2020;76:1368–83. 10.1161/HYPERTENSIONAHA.120.15873
    1. Miller ER, Erlinger TP, Young DR, et al. . Results of the diet, exercise, and weight loss intervention trial (DEW-IT). Hypertension 2002;40:612–8. 10.1161/01.hyp.0000037217.96002.8e
    1. Chang AR, Bailey-Davis L, Hetherington V, et al. . Remote dietary counseling using smartphone applications in patients with stages 1-3a chronic kidney disease: a mixed methods feasibility study. J Ren Nutr 2020;30:53–60. 10.1053/j.jrn.2019.03.080
    1. Barenbaum SR, Mathews SE, Saunders KH, et al. . Utility of BMIQ, a novel web-based weight management programme, at an academic weight management centre. Obes Sci Pract 2020;6:134–8. 10.1002/osp4.393
    1. Kristal AR, Kolar AS, Fisher JL, et al. . Evaluation of web-based, self-administered, graphical food frequency questionnaire. J Acad Nutr Diet 2014;114:613–21. 10.1016/j.jand.2013.11.017
    1. Carver C, Scheier M. On the self regulation of behavior. New York: Cambridge University Press, 1998.
    1. Lave J, Wenger E. Situated learning: legitimate peripheral participation. New York: Cambridge University Press, 1991.
    1. Baena Díez JM, Carrera Morodo M, Corral Roca M. Impact of the new criteria of the ACC/AHA on the diagnostic prevalence of hypertension. Med Clin 2020;154:254–6. 10.1016/j.medcli.2019.06.021
    1. de Greeff A, Shennan AH. Validation of the Spacelabs 90227 OnTrak device according to the European and British hypertension societies as well as the American protocols. Blood Press Monit 2020;25:110–4. 10.1097/MBP.0000000000000424
    1. Craig CL, Marshall AL, Sjöström M, et al. . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95. 10.1249/01.MSS.0000078924.61453.FB
    1. Reedy J, Lerman JL, Krebs-Smith SM, et al. . Evaluation of the healthy eating Index-2015. J Acad Nutr Diet 2018;118:1622–33. 10.1016/j.jand.2018.05.019
    1. Griebeler ML, Levis S, Beringer LM, et al. . Self-reported versus measured height and weight in Hispanic and non-Hispanic menopausal women. J Womens Health 2011;20:599–604. 10.1089/jwh.2009.1850
    1. Carranza Leon BG, Jensen MD, Hartman JJ, et al. . Self-Measured vs Professionally measured waist circumference. Ann Fam Med 2016;14:262–6. 10.1370/afm.1896
    1. Sikand G, Cole RE, Handu D, et al. . Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: a systematic review and meta-analysis. J Clin Lipidol 2018;12:1113–22. 10.1016/j.jacl.2018.06.016
    1. Hardy ST, Loehr LR, Butler KR, et al. . Reducing the blood pressure-related burden of cardiovascular disease: impact of achievable improvements in blood pressure prevention and control. J Am Heart Assoc 2015;4:e002276. 10.1161/JAHA.115.002276
    1. Juraschek SP, Miller ER, Weaver CM, et al. . Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. J Am Coll Cardiol 2017;70:2841–8. 10.1016/j.jacc.2017.10.011

Source: PubMed

3
订阅