Effectiveness of Lifestyle and Drug Intervention on Hypertensive Patients: a Randomized Community Intervention Trial in Rural China

J Gen Intern Med. 2020 Dec;35(12):3449-3457. doi: 10.1007/s11606-019-05601-7. Epub 2020 Oct 6.

Abstract

Background: Strict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow.

Objective: To evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients.

Design: Randomized community intervention trial.

Participants: The control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China.

Main measures: Data on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention.

Key results: BP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001).

Conclusion: The addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.

Keywords: blood pressure control rate; effectiveness; hypertension; lifestyle intervention.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents* / pharmacology
  • Antihypertensive Agents* / therapeutic use
  • Blood Pressure
  • China / epidemiology
  • Female
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / epidemiology
  • Life Style*
  • Male
  • Pharmaceutical Preparations

Substances

  • Antihypertensive Agents
  • Pharmaceutical Preparations