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]) base 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) (ΔSBP=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 Δpercentage of Fat (%Fat) and Δurinary 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. ΔU-Na was determined to significantly predict ΔSBP as assessed by step-wise selection. In addition, the partial correlation coefficient of ΔSBP with ΔU-Na was 0.361 (p=0.011) as assessed by a multiple regression analysis. Therefore, PACE+ Japan follow-up counseling was associated with a reduction in SBP, which in turn was associated with reduction in U-Na. This new program may be effective for reducing blood pressure in hypertensives.