Poggio R, Melendi SE, Beratarrechea A, et al. Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight. Am J Prev Med. 2019 Oct;57(4):438-446. doi: 10.1016/j.amepre.2019.05.011. Epub 2019 Aug 29. (Original study)

INTRODUCTION: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families.

STUDY DESIGN: Cluster randomized trial conducted between June 2013 and October 2016.

SETTING/PARTICIPANTS: A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina.

INTERVENTION: Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months.

MAIN OUTCOME MEASURES: Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017.

RESULTS: Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000).

CONCLUSIONS: The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina.

TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01834131.

Discipline Area Score
Physician 6 / 7
Nurse 6 / 7
Comments from MORE raters

Nurse rater

The number of participants are good and the quality seemed excellent.

Nurse rater

There seems to be a disconnect between the title of the paper and the contents. The paper describes an intensive effort by the Argentinian government to reduce hypertension in the lower economic strata by promoting the intake of fruits/vegetables and increasing physical activity while reducing sodium and alcohol intake. There was minimal to moderate increase in fruit/vegetable intake and improvement in physical activity observed but there does not seem to be mention of the impact of these efforts on the BP of the intervention group. Given that the intervention group did not appreciably reduce sodium consumption or alcohol, I don't think this paper describes anything other than observed behavior in response to an intervention.

Physician rater

It is expected not to affect body weight as this needs a face to face follow up and a structured menu plan. However, this would be difficult for that sample size.
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