Blood Pressure and Lifestyle

Hypertension Management in Primary Care—a Cluster Randomized Trial of a Physician-Focused Educational Intervention by Prof. Dr. med. Birgitta Weltermann, MPH; Christine Kersting, MA; and Dr. rer. medic Anja Viehmann in issue 10/2016

The article by Weltermann et al. is to be welcomed as a valuable contribution to health services research in the area of arterial hypertension. They collected important data in a methodologically sound way, by using cluster randomization and, remarkably, completely on the basis of 24-hour ambulatory blood pressure monitoring. These data may provide a basis for further investigations (1). What would have been desirable, however, is for results to be presented not only for blood pressure measurements, the number of antihypertensive drugs, or changes to clinical practice management, but also for lifestyle factors. These are mentioned as an endpoint in the methods section, but they are omitted from the results section. An effect on lifestyle is a factor that is neglected in clinical practice. According to a recent study, less than 10% were questioned about physical activity (2).

The positive effect of different, non-medication measures on blood pressure control is undisputed (3). Even if—for reasons clearly and persuasively discussed in the article—the present study did not show an unequivocal difference in blood pressure between the intervention and control groups, a focus on patients’ lifestyles might potentially have given indications of long-term effects relating to blood pressure and total cardiovascular risk. Such effects would be easy to study in the setting that the authors selected to conduct their study.

DOI: 10.3238/arztebl.2016.0604a

Prof. Dr. med. Burkhard Weisser

Christian-Albrechts-Universität zu Kiel

References

1. Weltermann B, Kersting C, Viehmann A: Hypertension management in primary care—a cluster randomized trial of a physician-focused educational intervention. Dtsch Arztebl Int 2016; 113: 167–74

2. Gabrys L, Jordan S, Behrens K, Schlaud M: Prevalence, current trends and regional differences of physical activity counseling in Germany. Dtsch Z Sportmed 2016; 67: 53–8

3. Appel LJ, Champagne CM, Harsha DW, et al.: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003; 289: 2083–93