The effect of a lifestyle modification adherence tool on risk factors in patients with chronic hypertension compared to usual management

• Main Author: Webber, Janine
• Format: Others
• Language: en
• Published: 2012
• Subjects: Hypertension|xprevention & control
• Online Access: http://hdl.handle.net/10539/11678

M.Sc. (Physiotherapy), Faculty of Health Sciences, University of the Witwatersrand, 2011 === Background Poor adherence to lifestyle interventions and medication-taking poses a problem universally. However, there are interventions to help patients adhere to treatment regimens and in turn, lower the risk of cardiovascular disease by decreasing blood pressure. These interventions need to be investigated further. Change in risk factors as a result of a lifestyle modification adherence tool in patients with chronic hypertension is not clear and will be further investigated in this study. Aim To determine the effect of a lifestyle modification adherence tool in patients with chronic hypertension and compare this with usual management. Objectives 1. To compare the changes in: · Blood pressure · Waist-hip ratio · Weight and body mass index · Blood glucose, cholesterol, triglycerides, HDL and LDL levels · Exercise Capacity between two experimental and one control group at baseline and after a six month intervention using a lifestyle modification tool 2. To determine the sustainability of the intervention three months after the intervention is concluded. Design The study design was a quantitative, longitudinal randomized control trial consisting of two experimental and one control group. Method Ninety subjects at the hypertension clinic at Helen Joseph Hospital were sampled consecutively and then randomized using computer generated randomization and concealed allocation. The study consisted of three groups, two experimental and one control group. All three groups underwent the usual treatment in the Hypertension Clinic. Experimental group one (EG1) received the Lifestyle Modification Adherence Tool (LMAT) as well as a once-a-month telephone call from the research assistant. Experimental group two (EG2) received only a once-a-month telephone call from the research assistant. The control group (CG) received the standard treatment at the clinic. The significance of the study was set at p=0.05. A Students t-test (independent) was used to compare variables between groups at baseline. The Pearsons Chi Square test was used to compare and analyze non parametric data at baseline. Change in blood pressure, waist-hip ratio, weight and body mass index, glucose levels and exercise capacity between control and intervention groups was established using an ANCOVA. Pairwise t-tests were used to compare p-values between groups one and two; one and three and; two and three. Results No reductions in weight and body mass index (BMI) were observed. Significant differences in EG1 for waist/hip ratios were noted compared with the EG2 (p=0.04) and CG (p=0.04) between month 0 and month 6. Blood pressure reductions were greater in EG1 compared with EG2 and the CG at six months but greater drops in blood pressure were noted in EG2 compared with EG1 and the CG between six and nine months. However, these differences were not significant. Significant reductions were observed in blood glucose levels in the EG1 compared with EG2 group between month 6 and month 9 (p=0.05). There were also significant reductions in the EG2 in triglycerides and low density lipoprotein (LDL) between month 0 and month 6 compared with the CG (p= 0.04 and p= 0.03 consecutively) and significant LDL reductions in both EG1 and EG2 between month 6 and month 9 compared with the CG (p= 0.02 for both comparisons). Walking distances improved minimally in both EG1 and EG2 but these changes were not significant. Conclusion Although not all results were significant, diary and telephone interventions and telephone only intervention to improve adherence did show a positive trend towards improvements in risk factors of patients with chronic hypertension.