• Jing Xiao, Wen-Long Ren, Yuan-Yuan Liang, Huan Shen, Yue-Xia Gao, Min-Jie Chu, Zhou Li, Xiao-Jian Wang, Zuo-Feng Zhang, Xun Zhuang, and Yong-Fu Yu.
• Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, People's Republic of China.
• J Gen Intern Med. 2020 Dec 1; 35 (12): 3449-3457.

BackgroundStrict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow.ObjectiveTo evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients.DesignRandomized community intervention trial.ParticipantsThe control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China.Main MeasuresData on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention.Key ResultsBP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001).ConclusionThe addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.

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