Our study collected data on physicians’ guideline-based lifestyle recommendations as well as on patients’ actual lifestyle modifications (1, 2). Methodologically, the lifestyle factors were co-factors, not endpoints. Additional details from our study:
- At baseline, 96% of the study patients had at least one lifestyle factor that could be optimized.
- Intervention practices recommended to reduce body weight and alcohol consumption significantly more frequently than control practices: physicians’ recommendations for weight reduction: 71% versus 50%, p=0.032; alcohol reduction: 25.8% versus 7.5%, p=0.020; increase physical activity: 77.4% versus 72.5%, p=0.573; reduce salt intake: 56.6% versus 50%, p=0.523; stop smoking: 27.4% versus 15%, p=0.143; reduce licorice consumption: 11.3% versus 10%, p=1.00. This was notably higher than in the study cited by Professor Weisser (3).
- Although 92% of patients in the intervention arm and 88% of patients in the control arm received recommendations for lifestyle modifications, no aspect changed to a relevant extent during the short 5-month follow-up period.
- In contrast to the PREMIER study (patient-centered behavioral intervention in patients with hypertension that is not treated medically) cited by Professor Weisser, the patient population in our study was clearly sicker: patients’ hypertension had been known for an average of 9 years (range 0–34 years), 56% had ≥1 cardiovascular sequela(e) and/or type 2 diabetes, and 95% were taking ≥1 antihypertensive medication(s).
Blood pressure lowering without medication requires particular motivation and adherence on behalf of the patients (4). Especially in secondary prevention, medication-mediated blood pressure lowering is reasonable until lifestyle modifications have an impact and, if possible, medications can be reduced or stopped. This approach leads to an early reduction of the cardiovascular risk, rather than tolerating years of insufficient blood pressure control while pointing out to patients that lifestyle modifications are required. We agree that intervention studies addressing lifestyle modifications which may include behavior therapeutic strategies will be useful in the general practice setting.
Prof. Dr. med. Birgitta Weltermann, MPH (USA)
Institut für Allgemeinmedizin
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
|1.||Mancia G, Fogard R, Narkiewicz K, et al.: 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31: 1925–38 CrossRef CrossRef MEDLINE|
|2.||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 VOLLTEXT|
|3.||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 CrossRef|
|4.||Dickinson HO1, Mason JM, Nicolson DJ, et al.: Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 2: 215–33 CrossRef MEDLINE|