REACH- Reducing Risk With E-based Support for Adherence to Lifestyle Change in Hypertension

This randomized controlled trial will evaluate whether preventive e-Counseling (Heart and Stroke Foundation Action Plan, HSF-AP; http://ww2.heartandstroke.ca/hs_bp2.asp?media=bp) improves blood pressure and lifestyle adherence among subjects diagnosed with Stage 1 or 2 hypertension.

Primary hypotheses.

1. e-Counseling (vs. Control) will significantly reduce SBP, DBP and pulse pressure (PP) at the 4-, 12-month outcomes, as measured by a validated protocol for automated BP assessment in the clinic23 which we have used in a previous trial.24
2. e-Counseling (vs. Control) will significantly reduce CVD risk, as measured by lipoprotein cholesterol (total, low-density, and total/high-density ratio) and the Framingham 10-year absolute CHD risk index.25

Secondary hypotheses:

1. e-Counseling (vs. Control) will significantly increase adherence to self-management behaviors at the 4- and 12-month outcomes, as measured by objective and validated indices:

   • mean 7-day step count recorded by accelerometry
   • dietary sodium ≤ 100 mmol/day measured by 24-hour urinary sodium
   • smoke-free living measured by salivary cotinine
   • fruit and vegetable intake ≥ 9 to12 servings/day, dietary fat < 25% and 2-3 dairy servings/day as measured by an NIH/NCI assessment26 that has been validated for Canadian samples.27.28
   • physical activity ≥150 minutes/week as measured by validated assessment29
2. Among subjects who are prescribed antihypertensive medications at baseline, e-Counseling (vs. Control) will significantly increase medication adherence as defined by pharmacy refill data and a validated medication compliance index that we have utilized in a previous trial.30 c.) Physical fitness is measured by the 6-minute walk test d.) Autonomic function and baroreceptor sensitivity are measured by ECG and finometer