Advice from primary-care physicians and nurses may improve diet in people with hypertension

Stevens, Victor J PhD

Kaiser Permanente Center for Health Research; Portland, Oregon, USA

Abstracted from:Korhonen M, Kastarinen M, Uusitupa M et al. The effect of intensified diet counseling on the diet of hypertensive subjects in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland. Prev Med 2003; 36: 8-16 .

Sources of funding: Social Insurance Institution of Finland; National Public Health Institute; Finnish Heart Association; Juho Vainio Foundation; Finnish Konkordia Foundation; Finnish Cultural Foundation of Northern Savo.

Correspondence to: M Korhonen, Department of Clinical Nutrition, University of Kuopio, Finland. Email: [email protected]

Abstract provided by Bazian Ltd, London

Note: A copy of this summary also appears in the June 2003 issue of Evidence-based Cardiovascular Medicine.

Evidence-based Healthcare 7(2):p 106-108, June 2003.

BACKGROUND

Non-pharmacological treatment is recommended for first-line management of elevated blood pressure. To prevent and treat hypertension, it is recommended that people reduce weight, dietary sodium, fat and alcohol intake.

OBJECTIVE

To assess the effect of intensified diet counselling in primary healthcare on the diet of people with hypertension.

SETTING

Nine primary-care centres in Eastern Finland; timeframe not specified.

METHOD

Randomised trial.

PARTICIPANTS

Seven hundred and fifteen community-living people aged between 25 and 74 years with drug treatment for hypertension or systolic blood pressure between 140 and 179 mmHg, diastolic blood pressure between 90 and 109 mmHg, or both. Mean age 54 years; 47% women; 53% receiving drug treatment for hypertension. Participants were recruited using newspaper advertisements and primary-care hypertension registers.

INTERVENTION

The intervention group were advised to reduce total fat, saturated fat and salt intake; increase monounsaturated and polyunsaturated fat intake; reduce weight, and consume alcohol in moderation. Primary-care physicians provided initial advice. Nurses provided ongoing support and counselling. Intervention group participants were scheduled for individual visits with a nurse four times during the first year (at 1, 3, 6 and 9 months) and three times during the second year (at 15, 18, and 21 months). The usual care group received no additional support. Follow-up occurred over 2 years. Follow-up was 83% at 1 year and 72% at 2 years.

OUTCOMES

Net changes in total fat intake, saturated fatty acid intake, body weight and sodium intake. Net changes were assessed using the change in the intervention group minus any change in the usual care group.

MAIN RESULTS

At 2 years, the intervention group had significantly better reductions in total fat intake, saturated fatty acid intake, body weight and daily sodium intake.

AUTHORS' CONCLUSIONS

Intensified diet counselling in primary care was associated with dietary changes in people with hypertension.