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Prescribing Medication Versus Promoting Behavioural Change: A Trial of the Use of Lifestyle Management to Replace Drug Treatment of Hypertension in General Practice

Published online by Cambridge University Press:  06 October 2014

Christopher M. Reid ,
Barbara Murphy ,
Michael Murphy ,
Thomas Maher ,
Denise Ruth  and
Garry Jennings
Christopher M. Reid*
Affiliation:
Baker Medical Research Institute
Barbara Murphy
Affiliation:
Baker Medical Research Institute
Michael Murphy
Affiliation:
Baker Medical Research Institute
Thomas Maher
Affiliation:
Baker Medical Research Institute
Denise Ruth
Affiliation:
Monash University
Garry Jennings
Affiliation:
Baker Medical Research Institute
*
Alfred and Baker Medical Unit, Baker Medical Research Institute, Commercial Road, Prahran VIC 3181, Australia. Telephone: 03 276 3270. Facsimile: 03 276 3488
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Abstract

Antihypertensive drug therapy may reverse the cardiac and vascular structural changes associated with sustained hypertension. This may enable appropriate blood pressure levels to be maintained with milder forms of therapy (such as lifestyle interventions) which will minimise any potential adverse effects of pharmacological therapy. The HEART project was conducted in the general practice setting and aimed to determine whether lifestyle strategies, such as increased physical activity and dietary modification, could be substituted for drug therapy in patients who had been well controlled on antihypertensive medication. In addition to objective measures of blood pressure and risk factor outcomes, attitudes and perceptions of general practitioners (GPs) and patients involved in the trial were assessed through focus group discussion and personal interviews. Of the 44 patients recruited to the trial, 41 (93%) participated in structured interviews of 20–40 minutes duration conducted in person or by telephone. Of 78 GPs working in the western suburbs of Melbourne who were approached about the trial, 50% were willing to participate. Of these, 13 (34%) recruited study patients. Of these 13, 10 (77%) participated in a 2-hour focus group discussion which was audiotaped for later transcription and analysis. Despite being enthusiastic about lifestyle interventions in principle, nearly all of these GPs felt resistant to the concept of withdrawing medication in well-controlled subjects. They were generally surprised to see that many patients (15 of 20 patients: 75%) were able to maintain appropriate blood pressure levels following drug therapy withdrawal and adoption of minimal lifestyle changes. GPs felt that the patients' eagerness to come off medication was the major incentive for patients to participate in the trial. This was corroborated by many patients indicating a desire not to be taking any medication. The majority of patients reported making minor changes in lifestyle behaviours leading to most being able to remain off therapy or to have drug dosage requirements reduced. The major barriers to maintaining lifestyle change were family and work stresses and the perception of the intervention not being treated as a therapy thus not at the same level of importance as a treatment method as drug therapy. It appears that a select group of hypertensive patients, highly motivated by the prospect of drug therapy withdrawal, were interested in and willing to trial a lifestyle behaviour change approach for their blood pressure management. The majority reported that they had been able to adopt small but meaningful changes in exercise and dietary habits through the provision of stand-alone self-help materials and support from their GP. Of these patients, 75% remained normotensive without drug therapy after a 9-month follow-up period.

Type
Research Article
Information
Behaviour Change , Volume 11 , Issue 3 , September 1994 , pp. 177 - 185
Copyright
Copyright © The Author(s) 1994

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References

REFERENCES

Alderman, M.H., & Lamport, B. (1990). Withdrawal of drug therapy. A component of the proper management of the hypertensive patient. In Laragh, J.H., & Brenner, B.M. (Eds.), Hypertension: Pathophysiology, diagnosis and management. New York: Raven Press.Google Scholar
Australian Bureau of Statistics. (1992). 1989–90 National health survey. Consultation with health professionals, Australia. Canberra: Author.Google Scholar
Basch, C.E. (1987). Focus group interveiws: An under-utilised research technique for improving theory and practice in health education. Health Education Quarterly, 14, 411–488.Google Scholar
Blaufox, M.D., Langford, H.G., Oberman, A., Hawkins, C.M., Wassertheil-Smoller, V., & Cutter, G.R. (1984). Effect of dietary change on the return of hypertension after withdrawal of prolonged antihypertensive therapy (DISH). Journal of Hypertension, 2 (Suppl 3), 179–181.Google Scholar
Bridges-Webb, C., Britt, H., Miles, D.A., Neary, S., Charles, J., & Traynor, V. (1992). Morbidity and treatment in general practice in Australia 1990-1991. Medical Journal of Australia, 157, S1–S56.Google Scholar
Consensus Panel (1994). The management of hypertension: A consensus statement. Medical Journal of Australia, 160, S1–S16.Google Scholar
Dahloff, B., Pennart, K., & Hannson, L. (1992). Reversal of left ventricular hypertrophy in hypertensive patients: A metaanalysis of 109 treatment studies. American Journal of Hypertension, 5, 95–110.Google Scholar
Fletcher, A.E., Franks, P.J., & Bulpitt, C.J. (1988). The effect of withdrawing antihypertensive therapy: A review. Journal of Hypertension, 6, 431–436.CrossRefGoogle ScholarPubMed
Goldman, S. (1991). A review of selected self-help literature. Melbourne: Department of Community Medicine, Monash University.Google Scholar
Guidelines Sub-Committee. (1993). 1993 guidelines for the management of mild hypertension: Memorandum from a World Health Organisation/International Society of Hypertension meeting. Journal of Hypertension, 11, 905–918.Google Scholar
Jennings, G.L., Korner, P.I., Laufer, E., Esler, M., Burton, D., & Bruce, A. (1984). How hypertension redevelops after the cessation of long term therapy. Journal of Hypertension, 2, 217–219.Google Scholar
Jennings, G., Nelson, L., Dewar, E., Korner, P., Esler, M., & Laufer, E. (1986a). Antihypertensive and haemodynamic effects of one year's regular exercise. Journal of Hypertension, 4, S659–S661.Google Scholar
Jennings, G.L., Nelson, L., Nestel, P., Esler, M., Korner, P., Burton, D., & Bazelmans, J. (1986b). The effects of changes in physical activity on major cardiovascular risk factors, haemodynamics, sympathetic function, and glucose utilization in man: A controlled study of four levels of activity. Circulation, 73, 30–39.Google Scholar
Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. (1993). The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNCV). Archives of Internal Medicine, 153, 154–183.Google Scholar
Korner, P.I., Jennings, G.L., Esler, M.D., Anderson, W.P., Adams, M., & Angus, J.A. (1987). The cardiovascular amplifiers in human primary hypertension and their role in a strategy for detecting underlying causes. Canadian Journal of Physiology and Pharmacology, 65, 1730–1738.CrossRefGoogle Scholar
MacMahon, S., Peto, R., & Cutler, J. (1990). Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: Prospective observational studies corrected for the regression dilution bias. Lancet, 335, 765–774.Google Scholar
MacMahon, S.W., Wilcken, D.E., & Macdonald, G.J. (1986). The effect of weight reduction on left ventricular mass. New England Journal of Medicine, 314, 334–339.Google Scholar
Martin, J.E., Dubbert, P. M., & Cushman, W.C. (1990). Controlled trial of aerobic exercise in hypertension. Circulation, 81, 1560–1567.Google Scholar
Parkerson, G.R., Broadhead, W.E., & Tse, C. (1991). Development of the 17–item Duke health profile. Family Practice, 8, 396–401.CrossRefGoogle ScholarPubMed
Prochaska, J.O., & DiClemente, C.C. (1983). Stages and processes of self-change of smoking toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.Google Scholar
Puddey, I.B., Beilin, L.J., Vandongen, R., Rouse, I.L., & Rogers, P. (1985). Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men: A randomised controlled trial. Hypertension, 7, 707–713.Google Scholar
Reid, C.M., Dart, A.M., Dewar, E.M., & Jennings, G.L. (1994). Interactions between the effects of exercise and weight loss on risk factors, cardiovascular haemodynamics and left ventricular structure in overweight subjects. Journal of Hypertension, 12, 291–301.Google Scholar
Reid, C.M., Murphy, B., Ruth, D., Maher, T., Charlwood, R., Lynch, M., & Jennings, G.L. (1993). Lifestyle management of hypertension in general practice. Health Promotion Journal of Australia, 3, 20–24.Google Scholar
Reisen, E., Abel, M.D., Modan, M., Silverberg, D.S., Eliahou, H.E., & Modan, B. (1978). Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. New England Journal of Medicine, 298, 1–6.Google Scholar
Rouse, I.L., Armstrong, B.K., Beilin, L.J., & Vandongen, R. (1983). Blood pressure lowering effect of a vegetarian diet: Controlled trial in normotensive subjects. Lancet, i, 5–9.Google Scholar
Rouse, I.L., Beilin, L.J., Mahoney, D.P., Margetts, B.M., Armstrong, B.K., Record, S.J., Vandongen, R., & Barden, A. (1986). Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with lacto-ovo-vegetarian diet. Journal of Hypertension, 4, 241–250.Google Scholar
Royal Australian College of General Practitioners (1991). Hypertension: Diagnosis, treatment and management. Adelaide: South Australian Health Commission.Google Scholar
Ruth, D., Cockburn, J., Farish, S., Piterman, L., & McConarchy, M. (1991). General practitioners reported practices and beliefs concerning the prevention of cardiovascular disease. Melbourne: Department of Community Medicine, Monash University.Google Scholar
Silagy, C., Sommer, S., & Piterman, L. (1992). Preventive care in general practice. Medical Journal of Australia, 156, 404–408.Google Scholar
Stamler, R., Stamler, J., Grimm, R., Gosch, F., Dyer, A., Berman, R., Civinelli, J., Elmer, P., Fishman, J., Van Heel, N., McDonald, A., & McKeever, P. (1984). Trial of control of hypertension by nutritional means: three year results. Journal of Hypertension, 2, 167–170.Google Scholar
Sudhir, K., Jennings, G.L., & Bruce, A. (1989). Cardiovascular-risk reduction: Initial diuretic therapy compared with calcium-antagonist (felodipine) therapy for primary hypertension. Medical Journal of Australia, 151, 277–279.Google Scholar
Thijs, L., Fagard, R., Lijnen, P., Staessen, J., Van Hoof, R., & Amery, A. (1992). A meta-analysis of outcome trials in elderly hypertensives. Journal of Hypertension, 10, 1103–1109.Google Scholar
Veterans Administration Cooperative Study Group on Antihypertensive Drugs (1975). Return of elevated blood pressure after withdrawal of antihypertensive drugs. Circulation, 51, 1107–1113.Google Scholar