Abstract P165: Key Tenets for Lifestyle Programs Aiming to Improve Hypertension Control and Cardiovascular Health

Abstract

Introduction: Promoting lifestyle changes, such as consuming a healthier diet, engaging in exercise, and quitting smoking can help control hypertension (HTN) and reduce the risk of adverse cardiac outcomes. To support public health practitioners and health care providers, the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) sought to develop a set of key tenets of lifestyle programs that support successful implementation and impact on HTN-related outcomes. Hypothesis: No a priori hypotheses. Methods: We conducted rapid evaluations of three lifestyle programs identified first through a broad call for nominations and then a panel of experts for final selections. We also performed a literature review to assess the landscape of lifestyle programs focused on managing HTN. To build upon these findings, a rigorous mixed-methods evaluation of a local YMCA’s (St. Louis Gateway Region) implementation of a Blood Pressure Self-Monitoring (BPSM) program was conducted to describe program characteristics and innovations and assess HTN outcomes. Results: The evaluation of a local YMCA included 333 participants with HTN (2018-2020) and reported a statistically significant average reduction of 2.6 mmHg in SBP from baseline to 16-week follow-up. Based on comprehensive findings from the project, DHDSP identified the following four key tenets for an effective program: 1) Implementing programs in community settings provides an opportunity to offer programming where people are already gathering and can build trust and commitment. Findings from rapid evaluation of a program held at churches and other community locations demonstrated increased BP control rates from 66.2% to 71.5% at 12-week follow-up. 2) A team-based approach with clinical and non-clinical staff allows for more impactful and effective implementation. Evaluation results demonstrated completion of a program with trained lifestyle coaches was associated with a decrease of 7.3 mmHg in SBP and 5.7 mmHg in DBP over a 16-week period. 3) Programs with shorter durations (between 3-24 weeks) allow for those not able to commit to a longer program to still benefit from learning to control BP and reduce other risk factors. Findings from rapid evaluation of a three-week program resulted in increased BP control from 28.4% to 61.3% by end of program period. 4) Targeting multiple lifestyle behaviors provide the opportunity to closely match participant needs with the type of activities that work best for them. Rapid evaluation of a 12-week program focused on exercise, diet, and reducing stress demonstrated an increase in BP control from 76.9% to 82.2%. Conclusion: Findings can be used as a resource to link patients to effective BP control and management programs that have implemented these key tenets. Strategies highlighted may also provide considerations for replication in other communities.