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Randomized Controlled Trial
. 2014 Apr;46(4):368-77.
doi: 10.1016/j.amepre.2013.11.009.

e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk

Beverly B Green  1 , Melissa L Anderson  2 , Andrea J Cook  2 , Sheryl Catz  2 , Paul A Fishman  2 , Jennifer B McClure  2 , Robert J Reid  2
Affiliations
Randomized Controlled Trial

e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk

Beverly B Green et al. Am J Prev Med. 2014 Apr.

Abstract

Background: Pharmacist- or nurse-led team care decreases patient blood pressure (BP) and cardiovascular disease (CVD) risk.

Purpose: To evaluate whether a Web-based dietitian-led (WD) team care intervention was feasible and resulted in decreased BP, CVD risk, and weight compared to usual care (UC).

Methods: Electronic health record (EHR) data identified patients aged 30-69 years with BMI >26, elevated BP, and 10%-25% 10-year Framingham CVD risk who were registered patient website users. Patients with uncontrolled BP at screening were randomized to UC or WD, which included a home BP monitor, scale, and dietitian team care. WD participants had a single in-person dietitian visit to obtain baseline information and create a plan to reduce CVD risk. Planned follow-up occurred via secure messaging to report BP, weight, and fruit and vegetable intake and receive ongoing feedback. If needed, dietitians encouraged patients and their physicians to intensify antihypertensive and lipid-lowering medications. Primary outcomes were change in systolic BP and weight loss ≥4 kg at 6 months. Feasibility outcomes included intervention utilization and satisfaction.

Results: Between 2010 and 2011, a total of 90 of 101 participants completed 6-month follow-ups. The WD group had higher rates of secure messaging utilization and patient satisfaction. The WD group lost significantly more weight than the UC group (adjusted net difference=-3.2 kg, 95% CI=-5.0, -1.5, p<0.001) and was more likely to lose ≥4 kg (adjusted relative risk [RRadj]=2.96, 95% CI=1.16, 7.53). BP control and CVD risk reduction were greater in WD than UC, but differences were not statistically significant.

Conclusions: WD intervention was feasible and resulted in decreased weight, BP, and CVD risk. A larger trial is justified.

Trial registration number: Trial Registration Number: NCT01077388.

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Figures

Figure 1
Figure 1
e-Care for heart wellness Consort diagram CVD, cardiovascular disease; BP, blood pressure
See this image and copyright information in PMC

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