A Review of Web-Based Interventions in Reducing Blood Pressure
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Abstract
Background: Elevated blood pressure (BP) is a leading risk factor for cardiovascular disease and mortality. Lifestyle interventions such as regular exercise and a healthy diet are recommended for reducing BP. It is estimated that the incidence of hypertension will double in the next 20 years; thus it is critical to develop an effective intervention to reduce BP without overtaxing health care resources. The internet may hold the potential to deliver a wide range of behavioral interventions to facilitate therapeutic change in lifestyle. The purpose of this review was to 1) examine the efficacy of web-based interventions in reducing BP and 2) identify trial attributes that appear to be mediators or moderators of BP reduction.
Method: MEDLINE, Pubmed, Embased and Cochrane Library were searched from 2000 to June 2012 using the following key words: Web-based, Internet, blood pressure and hypertension. Inclusion criteria for this review study were as follows: i) e-based intervneiton via website or e-mail, ii) clinical outcome included BP measurements iii) baseline BP was within the pre-hypertensive or hypertensive range (SBP/DBP: ≥120/80mmHg), iv) intervention administered within a randomized controlled trial, and v) study published in English. To allow comparison among studies, the effect size for the magnitude of BP change was calculated using Cohen’s formula.
Results: The search strategy identified 867 studies, of which 16 studies met the selection criteria. The intervention length ranged between 8 weeks to 12 months. Shorter interventions (≤6 months) showed a greater success in reducing BP than longer intervention (>6 months) (82% vs. 60%). The average reduction of systolic and diastolic BP across the 16 studies was -6.3 ±3.0 mmHg and -3.4 ±2.1 mmHg, respectively. In comparision to Control, 10 out of the 16 studies reported a significant reduction in both systolic and diastolic BP, while 2 studies only reported significant systolic BP decrease.. The mean effect size for systolic and diastolic BP was small, 0.41 and 0.17, respectively. Web-based interventions that targeted multiple behavioural targets such as modifying both exercise and diet had a greater chance in reducing BP than those studies that targeted either exercise or diet alone (85% vs. 33%). Interventions that did vs. did not proactively send out counselling messages to subjects had a greater success rate (90% vs. 40%). Only 4 of the 16 studies noted that the e-intervention explicitly utilized an established model of behavioural counselling. Three of those studies reported a positive BP outcome. However, none of the studies examined whether BP reduction was maintained after the intervention ended.
Conclusion: A theoretically grounded, evidence-based e-counseling intervention for BP reduction is still at an early phase of development. There is modest evidence of significant BP reduction using an e-based intervention. Components of e-counseling, such as targeting multiple behaviours and sending proactive messages, may improve efficacy. Future research needs to identify components of established models of behavioural counselling that may increase the long-term efficacy of e-based interventions.
Method: MEDLINE, Pubmed, Embased and Cochrane Library were searched from 2000 to June 2012 using the following key words: Web-based, Internet, blood pressure and hypertension. Inclusion criteria for this review study were as follows: i) e-based intervneiton via website or e-mail, ii) clinical outcome included BP measurements iii) baseline BP was within the pre-hypertensive or hypertensive range (SBP/DBP: ≥120/80mmHg), iv) intervention administered within a randomized controlled trial, and v) study published in English. To allow comparison among studies, the effect size for the magnitude of BP change was calculated using Cohen’s formula.
Results: The search strategy identified 867 studies, of which 16 studies met the selection criteria. The intervention length ranged between 8 weeks to 12 months. Shorter interventions (≤6 months) showed a greater success in reducing BP than longer intervention (>6 months) (82% vs. 60%). The average reduction of systolic and diastolic BP across the 16 studies was -6.3 ±3.0 mmHg and -3.4 ±2.1 mmHg, respectively. In comparision to Control, 10 out of the 16 studies reported a significant reduction in both systolic and diastolic BP, while 2 studies only reported significant systolic BP decrease.. The mean effect size for systolic and diastolic BP was small, 0.41 and 0.17, respectively. Web-based interventions that targeted multiple behavioural targets such as modifying both exercise and diet had a greater chance in reducing BP than those studies that targeted either exercise or diet alone (85% vs. 33%). Interventions that did vs. did not proactively send out counselling messages to subjects had a greater success rate (90% vs. 40%). Only 4 of the 16 studies noted that the e-intervention explicitly utilized an established model of behavioural counselling. Three of those studies reported a positive BP outcome. However, none of the studies examined whether BP reduction was maintained after the intervention ended.
Conclusion: A theoretically grounded, evidence-based e-counseling intervention for BP reduction is still at an early phase of development. There is modest evidence of significant BP reduction using an e-based intervention. Components of e-counseling, such as targeting multiple behaviours and sending proactive messages, may improve efficacy. Future research needs to identify components of established models of behavioural counselling that may increase the long-term efficacy of e-based interventions.
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