Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC 5475, Stanford, CA, 94305, USA.
Manila Doctors Hospital, Manila, Philippines.
J Community Health. 2020 Jun;45(3):478-487. doi: 10.1007/s10900-019-00764-0.
This study aims to determine the effectiveness of a monthly lifestyle education program, which included advice on nutritional changes and physical activity enhancement in the reduction of blood pressure and selected biochemical and anthropometric parameters among pre-hypertensive and stage 1 hypertensive participants in Manila, Philippines. Participants resided in two barangays (districts), in Manila, Philippines, and each barangay was assigned to either the intervention or attention-control group. The intervention group received monthly lectures on cardiovascular disease and organized classes on diet and exercise, while the attention-control group received monthly lectures on non-cardiovascular topics, with verbal advice that healthy diet and exercise are important. The primary outcome was systolic blood pressure, with secondary outcomes of BMI, waist circumference, and laboratory measures. Linear mixed effects models with an interaction between intervention group and time were used to estimate the 6-month change in each group. At 6 months, systolic blood pressure was lower in the intervention group compared to the attention-control group (- 12.7 mmHg (95% CI [- 14.5, - 10.9]) vs. - 0.24 mmHg (95% CI [- 1.87, 1.43]), p-value < 0.001). Waist circumference (p < 0.001), BMI (p < 0.001), and total cholesterol (p = 0.049) were also lower. However, no statistically significant difference in fasting glucose was observed between the two groups (p = 0.740). This study showed that participants receiving a non-pharmacological intervention, specifically a low-cost diet and active lifestyle education program, experienced a greater decrease in blood pressure, BMI, waist circumference, and total cholesterol than the attention-control group. Educational programs such as in ENLIGHTEN show promise for a developing country with limited resources to improve hypertension levels, and ultimately cardiovascular health. ENLIGHTEN deserves further study in randomized trials.
本研究旨在确定每月生活方式教育计划的有效性，该计划包括在菲律宾马尼拉的高血压前期和 1 期高血压参与者中，通过营养改变和增强体力活动的建议来降低血压和选定的生化及人体测量参数。参与者居住在菲律宾马尼拉的两个街区（区），每个街区被分配到干预组或对照组。干预组每月接受心血管疾病讲座，并组织关于饮食和运动的课程，而对照组每月接受非心血管主题的讲座，口头建议健康饮食和运动很重要。主要结果是收缩压，次要结果是 BMI、腰围和实验室指标。使用干预组和时间之间具有交互作用的线性混合效应模型来估计每组在 6 个月的变化。在 6 个月时，干预组的收缩压低于对照组（-12.7mmHg（95%CI[-14.5，-10.9]）与-0.24mmHg（95%CI[-1.87，1.43]），p 值<0.001）。腰围（p<0.001）、BMI（p<0.001）和总胆固醇（p=0.049）也较低。然而，两组间空腹血糖无统计学差异（p=0.740）。本研究表明，接受非药物干预的参与者，特别是接受低成本饮食和积极生活方式教育计划的参与者，血压、BMI、腰围和总胆固醇的下降幅度大于对照组。像 ENLIGHTEN 这样的教育计划有望为资源有限的发展中国家改善高血压水平，最终改善心血管健康。ENLIGHTEN 值得在随机试验中进一步研究。
