Efficacy of a Multicomponent Program (Patient-Centered Assessment and Counseling for Exercise plus Nutrition [PACE+ Japan]) for Lifestyle Modification in Patients with Essential Hypertension

Abstract

With conventional lifestyle modification programs, it can be difficult for hypertensive individuals to modify their lifestyles and maintain the changes. We assessed whether a multicomponent program (patient-centered assessment and counseling for exercise plus nutrition [PACE Japan]) based on behavior theory and social cognitive theory would be effective for treating patients with essential hypertension. We examined 57 outpatients aged 62 10 years with essential hypertension irrespective of antihypertensive drug treatment.Participants were randomly divided into two groups: 1) a PACE Japan follow-up group (n 18), who were given an action-plan sheet and systemic health counseling by a physician and counselor every 4 weeks for 24 weeks, and 2) a PACE Japan-only group (n 20), who were given an action-plan sheet but did not receive counseling. An age-and sex-matched control group (n 19) was also selected. The decrease in systolic blood pressure (SBP) ( SBP SBP at 24 weeks minus that at 0 weeks) in the PACE Japan follow-up group was significantly greater than that in the control group. In addition, the percentage of Fat (%Fat) and urinary sodium extraction (U-Na) in the PACE Japan follow-up group were significantly greater than those in the control group. With regard to changes in total energy expenditure, exercise energy expenditure and total energy intake between 0 weeks and 24 weeks, significant improvements were observed for the PACE Japan follow-up group. U-Na was determined to significantly predict SBP as assessed by stepwise selection. In addition, the partial correlation coefficient of SBP with U-Na was 0.361 ( p 0.

Long-Term Compliance with Salt Restriction in Japanese Hypertensive Patients

“…We have previously reported that there is no obvious reduction in the actual salt intake in saltconscious patients (13). Thus, repeated monitoring of urinary salt excretion, along with providing feedback to patients and follow-up counseling, seem to be the most important and practical way to achieve a reduction of salt intake in individual hypertensives (13,19).…”

The utilization of behavioural counselling for hypertension within a primary care context

“…The third study by Miura et al (2004) There were no significant differences in diastolic blood pressure among the three groups (no p values given). There was also significant decreases in percentage of body fat, urine sodium and total energy intake and significant increases in total energy expenditure and exercise energy expenditure for the PACE + Japan follow-up group.…”

“…Eight studies were identified and reviewed. Following a critical appraisal of the literature findings, five of the eight studies captured in the review highlight significant decreases in blood pressure related to the MI intervention (Ma et al, 2014;Ogedegbe et al, 2008;Schoenthaler et al, 2015;Svetkey et al, 2009;Woollard et al, 1995) and one study illustrated a non-significant decrease in systolic blood pressure (Miura et al, 2004). The remaining two studies showed no effect on blood pressure but did illustrate other efficacious effects on cholesterol, exercise capacity specifically minutes of walking per week and HbA1c levels (Hardcastle et al, 2013;Willard-Grace et al, 2015).…”

“…However, three randomized controlled trials looked specifically at the dose response of MI on measured outcomes (Hardcastle et al, 2013;Miura et al, 2004;Schoenthaler et al, 2015). All of these trials have similarities in that they provide written educational materials reinforcing lifestyle changes to the intervention groups.…”

“…All of these trials have similarities in that they provide written educational materials reinforcing lifestyle changes to the intervention groups. However, they differ with regards to the MI intervention: one trial offered up to five face-to-face counselling sessions of MI (Hardcastle et al, 2013); one offered a single counselling session versus an intervention of ten weekly classes followed by three individual MI sessions (Schoenthaler et al, 2015); and the last study offered six sessions of health counselling (Miura et al, 2004). The results of these trials are ambiguous as one study showed no significant effect on blood pressure outcomes (Hardcastle et al, 2013), while another indicated significant changes in both the high and low intervention groups with no significant difference between the two (Schoenthaler et al, 2015) and finally, the last trial showed significant difference in the MI group in comparison to usual care (Miura et al, 2004).…”