Abstract MP31: Telehealth Versus Self-directed Lifestyle Intervention To Promote Healthy Blood Pressure: A Randomized Controlled Trial

Abstract

Introduction: Telehealth and web-based applications are increasingly available to promote healthy lifestyle behavior change. However, evidence that these approaches lower blood pressure is limited. Methods: We conducted a randomized controlled trial to compare the efficacy of a self-directed vs. a telehealth-delivered dietitian approach using web-based applications in 187 participants (mean age 54.6 y, 52% female) with 24-hour systolic blood pressure (BP) 120-160 mmHg. Participants were recruited in the Geisinger Health System from 1/2019 to 3/2021. Both study arms received personalized recommendations to improve dietary quality based on web-based food frequency questionnaire, and access to an online comprehensive weight management program. The telehealth arm additionally received weekly telephone calls with a dietitian who used motivational interviewing. The primary outcome was 3-month change in 24-hour systolic BP. Secondary outcomes included changes in awake and sleep BP, self-reported physical activity, healthy eating index (HEI)-2015 score, and weight. Results: Twenty-four hour systolic BP improved in both the telehealth-dietitian arm (-6.5 mmHg, 95% CI: -8.4, -4.6) and the self-directed arm (-4.9, 95% CI: -7.0, -2.8), with no difference between arms (p=0.3). Participants in the telehealth-dietitian arm had significantly greater decreases in sleep systolic BP (mean -6.9 mmHg vs. -1.5; p=0.004) and diastolic BP (-3.3 mmHg vs. 0.7; p=0.001). The telehealth-dietitian arm tended to have greater improvements in self-reported physical activity, weight loss, and HEI-2015 score (Figure). Participant satisfaction with the intervention was higher in the telehealth-dietitian arm (p=0.004). Conclusions: Among individuals with elevated BP, the telehealth-dietitian intervention did not lower 24-hour systolic BP compared to the self-directed arm over 3 months. However, there were encouraging changes in other outcomes, including reduced sleep systolic and diastolic BP and increased physical activity.