Digital Health Program Effective for Obese Patients With Hypertension

A self-administered internet-based intervention resulted in positive short- and long-term health benefits in patients who were obese with hypertension, according to recent study findings.

Juan Francisco Lison, MD, PhD, and a team of colleagues investigated the efficacy in terms of body composition and blood pressure parameters of an internet-based intervention. The program had different modules and learning techniques to promote lifestyle changes including physical activity and healthy eating in patients with obesity and hypertension.

Lison, from the Department of Medicine at Cardenal Herrera University in Spain, and the investigators included adults between 18-65 years old with hypertension and who were overweight (BMI >24.9 kg/m² and <30 kg/m²) or had type 1 obesity (BMI >29.9 kg/m² and <35 kg/m²). The investigators defined hypertension as systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, or current use of antihypertensive medication.

Patients were excluded if they had a diagnosis of diabetes, previous ischemic heart disease, cerebrovascular disease, or a severe psychiatric disorder; if they took >3 antihypertensive drugs; had physical impairments precluding participation in physical activity; received any treatment for weight loss elsewhere; or had no access to internet.

The study included 105 participants who were randomly assigned either to the three-month internet-based intervention group (55 patients) or the wait-list control group (50).

The intervention program was called “Live better,” and those in the group received usual medical care and a three-month multimedia, interactive, and self-administered online program comprised of 9 modules. The modules focused on obesity and hypertension and were presented on a webpage which aimed to progressively establish healthy eating habits and increase the patient’s physical activity levels.

Each of the first 5 modules were activated 1 per week, and modules 6-9 were activated every 2 weeks.

Modules included psychoeducation about the meaning of a healthy lifestyle and how to achieve it on a daily basis. Techniques included self-instruction, self-reinforcement, behavioral recording, and homework.

For those in the wait-list control group, patients received standard medical care focused on reducing their cardiovascular risks factors. Standard care included antihypertensive prescription; written lifestyle advice; moderate salt restriction with a list of recommended foods; a low-calorie diet; and advice for physical activity.

The team measured BMI using a body-fat analyzer and used other tests to measure secondary outcomes.

Overall, 510 participants were screened, and 105 were deemed eligible. A two-way analysis showed a significant decrease in BMI, body fat mass, and blood glucose after 3 months in the intervention group, with moderate to large effect size for BMI and body fat mass. There was a borderline significant trend (P=.05) for diastolic blood pressure and insulin.

In the wait-list control group, there was a significant increase in BMI and insulin.

In the intervention and control groups, there was a statistically significant increase in the functional capacity for aerobic exercise.

At 12-months of follow up, there were significant improvements in BMI (mean difference [MD], −.4; 95% CI, −.1 to −.6; P=.005), body fat mass (MD, −2.4; 95% CI, −1.1 to −3.6; P <.001), diastolic blood pressure (MD, −1.8; 95% CI, −.2 to −3.3; P=.03), and blood glucose levels (MD, −2; 95% CI, 0 to −4; P=.04).

Nearly 75% of the intervention group completed the nine-module program.

The findings suggested that the tailored approach for delivering lifestyle changes virtually to patients who were obese with hypertension had positive health benefits.

Additional research could investigate the acceptability and cost-effectiveness of such programs in populations with varied sociodemographic status.

The study, “Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial,” was published online in the Journal of Medical Internet Research.