title: Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR) Effects of salt substitute on pulse wave analysis among individuals at high cardiovascular risk in rural China: a randomized controlled trial Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Effects of diet and lifestyle changes on atherosclerotic risk factors after 24 weeks on the Indian Diet Heart Study. Lowered risks of hypertension and cerebrovascular disease after vitamin/mineral supplementation: the Linxian Nutrition Intervention Trial. Strength and power training did not modify cardiovascular responses to aerobic exercise in elderly subjects. Two Distinct Training Methods for a Doctrine of Life with Healthy Heart in a Low Socioeconomic Society Model Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial [Lack of influence of body mass on blood pressure reduction after exercising]. [A strategic family medicine model for controlling borderline and mild arterial hypertension]. [Evaluation of the state intervention project to improve quality of life and reduce the complications associated with aging: "Add health to your years"]. Comparison of relaxation techniques, routine blood pressure measurements, and self-learning packages in hypertension control. Comparative Effect of Interval and Continuous Training Programs on Serum Uric Acid in Management of Hypertension: A Randomized Controlled Trial The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. A significant decrease in blood pressure through a family-based nutrition health education programme among community residents in Taiwan. Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes. Improving control of high blood pressure among middle-aged Turkish women of low socio-economic status through public health training. A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa. Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Reduction of global cardiovascular risk with nutritional versus nutritional plus physical activity intervention in Colombian adults [The influence of programmed physical activity on blood pressure of hypertensive elderly patients on non-pharmacological treatment]. An integrated intervention program to control diabetes in overweight Chinese women and men with type 2 diabetes. Trends in the prevalence, awareness, treatment and control of hypertension: the WHO MONICA Project The Effects of Yoga on Hypertensive Persons in Thailand Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting.
abstract: Background Cardiovascular disease remains the leading killer of women in most developed areas of the world . Rates of physical inactivity and poor nutrition , which are two of the most important modifiable risk factors for cardiovascular disease in women , are substantial . This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women 's physical activity in a r and omized trial guided by community-based participatory research ( CBPR ) methods . Methods A total of 335 healthy , 25–64 years old women who had been selected by a multiple-stage stratified cluster r and om sampling method in Bushehr Port/I.R. Iran , were r and omized into control and intervention groups . The intervention group completed an 8-week lifestyle modification program for increasing their physical activity , based on a revised form of Choose to Move program ; an American Heart Association Physical Activity Program for Women . Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations . Results Among the participants , the percentage who reported being active ( at lease 30 minutes of moderate intensity physical activity for at least 5 days a week , or at least 20 minutes of vigorous physical activity for at least three days a week ) increased from 3 % and 2.7 % at baseline to 13.4 % and 3 % ( p < 0.0001 ) at the ending of the program in the intervention and control groups , respectively . The participants in the intervention group reported more minutes of physical activity per week ( mean = 139.81 , SE = 23.35 ) than women in the control group ( mean = 40.14 , SE = 12.65 ) at week 8 ( p < 0.0001 ) . The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure ( -10.0 mmHg ) than the control group women ( + 2.0 . mmHg ) . The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77 , respectively ( P < 0.0001 ) . Conclusion An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women . The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion . Trial Registration Reduced-sodium , increased-potassium salt substitutes lower blood pressure but may also have direct effects on vascular structure and arterial function . This study aim ed to test the effects of long-term salt substitution on indices of these outcomes . The China Salt Substitute Study was a r and omized , controlled trial design ed to establish the effects of salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulfate ) compared with regular salt ( 100 % sodium chloride ) on blood pressure among 600 high-risk individuals living in six rural areas in northern China over a 12-month intervention period . Data on central aortic blood pressure , aortic pressure augmentation ( AUG ) , augmentation index ( AIx ) , the differences of the peak of first and baseline waves ( P1–P0 ) and pulse wave reflection time ( RT ) were collected at r and omization and at the completion of follow-up in 187 participants using the Sphygmocor pulse wave analysis system . Mean baseline blood pressure was 150.1/91.4 mm Hg , mean age was 58.4 years , 41 % were male and three quarters had a history of vascular disease . After 12 months of intervention , there were significant net reductions in peripheral ( 7.4 mm Hg , P=0.009 ) and central ( 6.9 mm Hg , P=0.011 ) systolic blood pressure levels and central pulse pressure ( 4.5 mm Hg , P=0.012 ) and correspondingly there was a significant net reduction in P1–P0 ( 3.0 mm Hg , P=0.007 ) , borderline significant net reduction in AUG ( 1.5 mm Hg , P=0.074 ) and significant net increase in RT ( 2.59 ms , P=0.001 ) . There were no detectable reductions in peripheral ( 2.8 mm Hg , P=0.14 ) or central ( 2.4 mm Hg , P=0.13 ) diastolic blood pressure levels or AIx ( 0.06 % , P=0.96 ) . In conclusion , over the 12-month study period the salt substitute significantly reduced not only peripheral and central systolic blood pressure but also reduced arterial stiffness OBJECTIVE The prevalence of type 2 diabetes , especially in developing countries , has grown over the past decades . We performed a controlled clinical study to determine whether a community-based , group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica . RESEARCH DESIGN AND METHODS A total of 75 adults with type 2 diabetes , mean age 59 years , were r and omly assigned to the intervention group or the control group . All participants received basic diabetes education . The subjects in the intervention group participated in 11 weekly nutrition classes ( 90 min each session ) . Subjects for whom exercise was deemed safe also participated in triweekly walking groups ( 60 min each session ) . Glycosylated hemoglobin , fasting plasma glucose , total cholesterol , triglycerides , HDL and LDL cholesterol , height , weight , BMI , and blood pressure were measured at baseline and the end of the study ( after 12 weeks ) . RESULTS The intervention group lost 1.0 + /- 2.2 kg compared with a weight gain in the control group of 0.4 + /- 2.3 kg ( P = 0.028 ) . Fasting plasma glucose decreased 19 + /- 55 mg/dl in the intervention group and increased 16 + /- 78 mg/dl in the control group ( P = 0.048 ) . Glycosylated hemoglobin decreased 1.8 + /- 2.3 % in the intervention group and 0.4 + /- 2.3 % in the control group ( P = 0.028 ) . CONCLUSIONS Glycemic control of type 2 diabetic patients can be improved through community-based , group-centered public health interventions addressing nutrition and exercise . This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes In a r and omized , single-blind , controlled trial , 621 patients were assigned either intervention diet A ( group A , 310 patients ) or control diet B  ( group B , 311 patients ) for a period of 24 weeks . After 24 weeks as revealed by dietary question naires , group A patients received : ( 1 ) a diet with a higher percentage of calories from fruits and vegetables and complex carbohydrates ; ( 2 ) a higher polyunsaturated/saturated fat ratio diet ; and ( 3 ) a larger amount of soluble dietary fiber , antioxidant vitamins and minerals and low saturated fat and cholesterol than group B. Group A patients also did more physical and yogic exercises than group B. Adherence to diet and exercise was obtained through question naires and information obtained was quantified into a formula . After 24 weeks , the overall score of diet and exercises  was significantly higher in group A than in group B. There was a significant decrease in serum total cholesterol ( 13.3 % ) , low-density lipoprotein cholesterol ( 16.9 % ) , triglycerides ( 19.2 % ) , fasting blood glucose ( 19.5 % ) and blood pressures ( 11.5/6.2 mm Hg ) in the intervention group compared with initial levels and changes in group B. The effect of  exercise  on the decrease in risk factors was additive . Within group A , overall score for diet and exercise  was greater in 1 subset of 116 patients in the intervention group which had maximal lifestyle changes . A separate analysis of data in this subgroup revealed a greater decrease in risk factors compared with risk factor changes in the remaining 194 patients with less higher overall score ; this indicated that the relation of lifestyle changes with reduction in risk factors may be of causal nature . ( ABSTRACT TRUNCATED AT 250 WORDS A total of 3,318 men and women from a region in rural China were r and omized to receive daily either a multiple vitamin/mineral supplement or a placebo . Deaths that occurred in the participants were ascertained and classified according to cause over the 6-year period from 1985 to 1991 . At the end of supplementation , blood pressure readings were taken , and the prevalence of hypertension was determined . There was a slight reduction in overall mortality in the supplement group ( relative risk ( RR ) = 0.93 , 95 percent confidence interval ( CI ) 0.75 - 1.16 ) , with the decreased relative risk most pronounced for cerebrovascular disease deaths ( RR = 0.63 , 95 percent CI 0.37 - 1.07 ) . This benefit was greater for men ( RR = 0.42 , 95 percent CI 0.19 - 0.93 ) than for women ( RR = 0.93 , 95 percent CI 0.44 - 1.98 ) . Among the survivors , the presence of elevations in both systolic and diastolic blood pressures was less common in those who received the supplement ( RR for men = 0.43 , 95 % CI 0.28 - 0.65 ; RR for women = 0.92 , 95 percent CI 0.68 - 1.24 ) . This study indicates that supplementation with a multivitamin/mineral combination may have reduced mortality from cerebrovascular disease and the prevalence of hypertension in this rural population with a micronutrient-poor diet Resistance training increases muscle strength in older adults , decreasing the effort necessary for executing physical tasks , and reducing cardiovascular load during exercise . This hypothesis has been confirmed during strength-based activities , but not during aerobic-based activities . This study determined whether different resistance training regimens , strength training ( ST , constant movement velocity ) or power training ( PT , concentric phase performed as fast as possible ) can blunt the increase in cardiovascular load during an aerobic stimulus . Older adults ( 63.9 ± 0.7 years ) were r and omly allocated to : control ( N = 11 ) , ST ( N = 13 , twice a week , 70 - 90 % 1-RM ) and PT ( N = 15 , twice a week , 30 - 50 % 1-RM ) groups . Before and after 16 weeks , oxygen uptake ( VO(2 ) ) , systolic blood pressure ( SBP ) , heart rate ( HR ) , and rate pressure product ( RPP ) were measured during a maximal treadmill test . Resting SBP and RPP were similarly reduced in all groups ( combined data = -5.7 ± 1.2 and -5.0 ± 1.7 % , respectively , P < 0.05 ) . Maximal SBP , HR and RPP did not change . The increase in measured VO(2 ) , HR and RPP for the increment in estimated VO(2 ) ( absolute load ) decreased similarly in all groups ( combined data = -9.1 ± 2.6 , -14.1 ± 3.9 , -14.2 ± 3.0 % , respectively , P < 0.05 ) , while the increments in the cardiovascular variables for the increase in measured VO(2 ) did not change . In elderly subjects , ST and PT did not blunt submaximal or maximal HR , SBP and RPP increases during the maximal exercise test , showing that they did not reduce cardiovascular stress during aerobic tasks This study was conducted in three stages in a semi-rural region of Eskisehir , Turkey . In the first stage , individuals selected by r and om sampling  were evaluated for cardiovascular disease risk factors . In the second stage , Group I and Group II training material s were r and omly distributed . In the third stage , the subjects were screened one year later to assess and determine if there had been any changes in their attitudes towards the dangers of cardiovascular diseases . The number of active smokers significantly decreased after the training in the both groups . The percentage of people with regulated blood pressure exhibited an increase in Group II more than Group Objective Dietary sodium and potassium consumption is associated with  blood pressure levels . The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese . Methods This study was a double-blind , r and omized , controlled trial design ed to establish the long-term effects of a reduced-sodium , high-potassium salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulphate ) compared to normal salt ( 100 % sodium chloride ) on blood pressure among high-risk individuals . Following a 4-week run-in period on salt substitute , participants were r and omly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period . Results The mean age of the 608 r and omized participants was 60 years and 56 % of them were female . Sixty-four percent had a history of vascular disease and 61 % were taking one or more blood pressure-lowering drugs at entry .  Mean baseline blood pressure was 159/93 mmHg ( SD 26/14 ) . The mean overall difference in systolic blood pressure between r and omized groups was 3.7 mmHg ( 95 % confidence interval 1.6–5.9 , P < 0.001 ) . There was strong evidence that the magnitude of this reduction increased over time ( P = 0.001 ) with the maximum net reduction of 5.4 mmHg ( 2.3–8.5 ) achieved at 12 months . There were no detectable effects on diastolic blood pressure . Conclusion Salt substitution produced a substantial and sustained systolic blood pressure reduction in this population , and should be actively promoted as a low-cost alternate or adjunct to drug therapy for people consuming significant quantities of salt BACKGROUND Hypertension ( H ) is associated with a large number of co-morbidities , including obesity . The correlation between two variables has been investigated . OBJECTIVE To analyze the correlation between the loss of body mass and blood pressure reduction in hypertensive patients undergoing exercising programs ( EP ) .  METHODS One hundred eleven hypertensive patients with overweight or obesity were r and omly divided into an experimental group ( EG ) . Out of these , 57 ( 58 + /- 8.9 years old ) participated in a three-month EP conducted three times a week in aerobic exercise sessions from 50 % to 70 % of VO2 peak for 30 to 60 minutes and resistance exercises ; and a control group ( CG ) with 54 ( 60 + /- 7.7 years old ) who did not participate in the EP . In the EG , blood pressure ( BP ) was measured before each session and the measurement of anthropometric variables ( AV ) at the beginning of the program and after three months . In the CG the BP and the VA were evaluated in the doctor 's office at the beginning and at the end of the study . Data were expressed as mean + /- st and ard deviation ( SD ) . Pearson correlation and t test were used . A value of p < 0.05 was considered significant . RESULTS In the CG there was no significant difference in AV and BP at the beginning and at the end of the study . In the EG , there was no significant alteration in the AV , however , there was blood pressure reduction of 12 % in systolic BP ( -17.5 mmHg , p = 0.001 ) and 9 % in Diastolic BP ( -8.1 mmHg , p = 0 . 01 ) at the end of the study . There was no correlation between the AV and decrease in BP ( r = 0.1 ) . CONCLUSION The blood pressure reduction was not correlated with reduction of anthropometric measures after the exercising period OBJECTIVE To research on the relationship of the patient and his/her family as a non-pharmacological factor for  blood hypertension .  To determine whether a hyposodic , hypocaloric , hypofat , and hypocholesterolemic diet decreases the blood tension . To determine whether physical exercises in the patient and his/her family help to reduce the hypertension . To observe whether the psychological therapy of muscles relaxation helps to reduce the hypertension . To evaluate in the sample of families , the experience of each member , as well as their suggestions and complaints about the programme . To design the strategic model to control the blood tension by ambulatory means . DESIGN Controlled intervention study , descriptive , non-r and omized , prospect i ve . PLACEMENT : Primary care . PATIENTS AND OTHER PARTICIPANTS Study group of 10 patients , 10 wives , and 12 children , and control group of 10 patients excluding family members . INTERVENTIONS With both groups ( study and control ) there were meetings every 15 days for 6 months according to an established schedule . In the meetings there were given talks , pamphlets , physical exercises , muscles relaxation therapy , all about blood hypertension . There were question naires before and after each activity . MEASURING AND MAIN RESULTS : In both groups ( study and control ) there was a statistically significant ( t < 0.01 ) reduction in the weight . The blood systolic tension decreased in both positions , seated and st and ing , in the study group ( difference statistically significant ) but not so in the control group , although there was a non-significant difference ( decrease of 1.5 mmHg ) in the seated position . The diastolic tension decreased significantly in the study group both in seated and st and ing positions , not so in the control group . CONCLUSIONS The study sample showed that systolic tension seated and st and ing had a statistically significant reduction in the study group but not so in the control group . The weight had statistically significant reduction in both study and control groups . Total cholesterol had statistically significant decrease in the study group but not in the control group . HDL-C had statistically significant reduction in the study group ; in the control group there was a decrease but not statistically significant . The triglycerides did not decrease statistically significant in any of the groups ( study and control ) OBJECTIVE This paper evaluates the effectiveness of a Public Health program for the elderly based on health promotion and pathologies prevention , in order to avoid complications associated with illnesses and improves the quality of life ( QOL ) in elderly adults ( EA ) . METHODS A 12 month intervention studies used 700 EA r and omized in 2 groups : intervention and control . Each group was su bmi tted to pre-post intervention measurements that included weight , height , blood pressure ( BP ) , cholesterol , lipids , glycaemia , cardiovascular ( infa rct , stroke ) and bone fractures events , hospitalization , and a QOL survey . Intervention consisted of periodic physical activity to fortify muscular groups , as well as recreational activities , nutritional and food manipulation training visits . A medical student was assigned to each participant from the intervention group to assure periodical contact and to share activities . The control group continued with their normal activities during observational period . RESULTS The intervention group showed a significant reduction in the BP , lipids and cholesterol values compared to control group . Reduction on cardiovascular events ( -31 % ) , hip fractures ( -18.2 % ) and number of hospital admittance ( -21.1 % ) were obtained for group A in relation to B. The QOL survey showed 28.7 % improvement for group A compared with 33.4 % improvement compared with control group . CONCLUSION The health program with exhaustive follow-up administration , significantly reduced risk factors and complications associated with aging BACKGROUND Even though the effectiveness of mediation and relaxation skills is controversial in blood pressure control , extensive field studies are limited . A national study targeting 50 communities r and omly selected from northern Taiwan was conducted to test and compare the effectiveness of hypertension control incorporating three strategies . METHODS Five hundred ninety hypertensives identified from 3,128 adults at a screening survey among the 50 communities were invited to participate in the study and were r and omly assigned to three treatment modalities , ( a ) relaxation techniques training at home , ( b ) routine blood pressure measurement by a health professional , and ( c ) reading self-learning packages , or to a control group . RESULTS After a 2-month intervention period , the three treatment groups showed a significant reduction in systolic blood pressure levels compared with the control group ( 11.0 mm Hg for group 1 , 9.2 mm Hg for group 2 , and 5.1 mm Hg for group 3 ) . The relaxation group had the most significant reduction in systolic blood pressure levels , followed by the routine blood pressure monitoring group and the self-learning group . However , the effect of relaxation training at home was not significantly greater than routine blood pressure measurement by a health professional Lamina , S. Comparative effect of interval and continuous training programs on serum uric acid in management of hypertension : a r and omized controlled trial . J Strength Cond Res 25(3 ) : 719 - 726 , 2011-The purpose of the study was to investigate the effect of interval and continuous training program on blood pressure and serum uric acid ( SUA ) levels in subjects with hypertension . Three hundred and fifty-seven male patients with mild to moderate systolic blood pressure ( SBP ) between 140 and 179 and diastolic blood pressure ( DBP ) between 90 and 109 mm Hg essential hypertension were age-matched and grouped into interval , continuous , and control groups . The interval ( work : rest ratio of 1:1 ) and continuous groups were involved in an 8-week interval and continuous training program of 45 - 60 minutes , at intensities of 60 - 79 % of heart rate maximum , whereas the control group remained sedentary during this period . SBP , DBP , maximum oxygen uptake ( & OV0312;o2max ) and SUA concentration were assessed . One-way analysis of variance and Scheffe and Pearson correlation tests were used in data analysis . Findings of the study revealed significant effect of exercise training program  on & OV0312;o2max , SBP , DBP , and SUA . However , there was no significant difference between the interval and continuous groups . Changes in & OV0312;o2max negatively correlated with changes in SUA ( r = −0.220 ) at p < 0.05 . It was concluded that both moderate-intensity interval and continuous training programs are effective and neither seems superior to the other in the nonpharmacological management of hypertension and may prevent cardiovascular events through the downregulation of SUA in hypertension . Findings of the study support the recommendations of moderate-intensity interval and continuous training programs as adjuncts for nonpharmacological management of essential hypertension OBJECTIVES To evaluate the effects on blood pressure , lipid profile , and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program . DESIGN R and omized controlled study of a Tai Chi Chuan group and a group of sedentary life controls . SETTING Taipei Medical University Hospitals and University campus in the Taipei , Taiwan , area . SUBJECTS Two ( 2 ) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension . INTERVENTION A 12-week Tai Chi Chuan exercise training program was practice d regularly with a frequency of 3 times per week . Each session included 10-minute warm-up , 30-minute Tai Chi exercise , 10-minute cool-down . Exercise intensity was estimated to be approximately 64 % of maximal heart rate . OUTCOME MEASURES Blood pressure , lipid profile and anxiety status ( State-Trait Anxiety Inventory ; STAI ) were evaluated . RESULTS After 12-weeks of Tai Chi training , the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg . The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. By using STAI evaluation , both trait anxiety and state anxiety were decreased . CONCLUSIONS This study shows that under well- design ed conditions , Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects ' anxiety status . Therefore , Tai Chi could be used as an alternative modality in treating patients with mild hypertension , with a promising economic effect OBJECTIVE To evaluate the effect on decrease in blood pressure of modifying risk factors for stroke , such as blood lipid profiles , diet habits and indices of body weight , through a family-based nutrition health education programme among hypertensive patients and pre-hypertensive subjects without taking any antihypertensive drugs . DESIGN AND SETTING This was a community-based prospect i ve study . The study population was r and omly selected from communities in Taipei ; potential subjects were invited by telephone to participate . SUBJECTS After excluding subjects whose blood pressure was normal and those using antihypertensive drugs , there were 390 participants included in the study . Subjects in the intervention group ( n 293 ) received nutrition health education on blood pressure control and stroke-related risk factor modification at each visit . Non-intervention subjects ( n 97 ) only acquired a general education sheet available in clinics . The blood pressure of study subjects was measured at baseline and 6-month follow-up to evaluate the intervention 's effect on decrease in blood pressure . RESULTS Significant decreases of 2.0 mmHg and 5.9 mmHg in systolic blood pressure were observed both in pre-hypertensive and hypertensive subjects in the intervention group . Additionally , intervention subjects with improvement of total cholesterol and LDL cholesterol , decrease in indices of body weight and increase in consumption of fruit and vegetables also had significant lowering of blood pressure . CONCLUSIONS The present study provided evidence that the blood pressure of pre-hypertensive and hypertensive subjects could decrease significantly , without taking antihypertensive drugs , after modifying blood lipid profiles and waist by dietary habits changed through a family-based nutrition heath education programme , result ing in a significant effect on stroke risk reduction BACKGROUND The aging process is associated with the development of several diseases , which can be attenuated by the practice of physical activities . Aerobic training is an effective method to maintain and improve cardiovascular function . Additionally , it has a crucial role in the prevention and treatment of several chronic-degenerative diseases , especially diabetes mellitus . } OBJECTIVE To verify the effect of a 13-week aerobic training program on blood pressure ( BP ) , body mass index ( BMI ) and glycemia levels in elderly women with type-2 diabetes mellitus ( DM2 ) . METHODS Eleven sedentary elderly women with DM2 , aged 61.0 ± 9.1 years , were su bmi tted a 13-week aerobic training program , constituting group G2 . Eleven controlled elderly women ( aged 60.2 ± 6.8 years ) were not su bmi tted to the aerobic training , constituting the control group ( G1 ) . G1 attended educational lectures once a week , whereas G2 walked three times a week . RESULTS Both groups presented a significant decrease in glycemia and diastolic blood pressure levels . No significant decreases in BMI were observed after the aerobic training in either group . CONCLUSION The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels ; therefore , this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases AIM To assess the effects of health training course aim ed at educating middle-aged women of low socio-economic status in Turkey how to better control high blood pressure . METHODS The intervention study included 400 r and omly selected women aged ( mean+/-st and ard deviation ) 34.1+/-8.6 years . After their body size and blood pressure were measured , the women were r and omly divided into two groups . The intervention group underwent public health training on high blood pressure control and obesity reduction , whereas control group had no training at all . After six months , blood pressure and body size of women in both groups were measured again . RESULTS Overall , the initial high blood pressure and obesity ratio in the intervention and control group were 20.0 % and 31.7 % , respectively . After 6 months of the intervention program , the number of women within the optimal weight range significantly increased in the intervention group compared with control group ( p=0.009 ) . After the intervention program , the number of women with normal weight and normal blood pressure in the intervention group significantly increased ( weight : 130 women before vs 150 after , p=0.001 ; blood pressure : 160 women before vs 173 after , p<0.001 ) . After the intervention , the percentage of meals consisting of fried food in the intervention group was lower by 31.9 % , and by 5.0 % in the control group . After the intervention the percentage of boiled food increased by 15.7 % in the intervention group , compared with no change in the control group . The consumption of food high in salt decreased by 5.5 % in the control and by 72.2 % in the intervention group . Similarly , the percentage of women who exercised almost doubled in the intervention group , whereas there was no change in the control group . CONCLUSION The changes in the lifestyle significantly reduced  hypertension and obesity ratio among women . The public health center can provide initial health training support as a part of the broader public health management program , aim ed at helping people tackle health problems OBJECTIVE To assess the impact of a food-based intervention on blood pressure ( BP ) in free-living South African men and women aged 50 - 75 years , with drug-treated mild-to-moderate hypertension . METHODS A double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects r and omised to an intervention ( n 40 ) or control ( n 40 ) arm . The intervention was 8-week provision of six food items with a modified cation content ( salt replacement ( SOLO ) , bread , margarine , stock cubes , soup mix and a flavour enhancer ) and 500 ml of maas ( fermented milk)/d . The control diet provided the same quantities of the targeted foods but of st and ard commercial composition and 500 ml/d of artificially sweetened cooldrink . FINDINGS The intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6.2 mmHg ( 95 % CI 0.9 , 11.4 ) for systolic BP . The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5.1 mmHg ( 95 % CI 0.4 , 9.9 ) . For wake diastolic BP the reduction was 2.7 mmHg ( 95 % CI -0.2 , 5.6 ) . CONCLUSIONS Modification of the cation content of a limited number of commonly consumed foods lowers BP by a clinical ly significant magnitude in treated South African hypertensive patients of low socio-economic status . The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies Background Exercise-based cardiac rehabilitation improves exercise capacity and reduces cardiac risk factors . The purpose of this pilot study was to examine the effects of a home-based cardiac exercise program ( HBCEP ) on exercise tolerance , serum lipids , and self-efficacy in coronary heart disease patients in Turkey . Self-efficacy theory provided the framework for this study 's intervention . Design The study design was a pre-test and post-test experimental , r and omized assignment . Method The study included 30 participants in a home-based cardiac exercise program ( HBCEP ; mean age = 54.7 ± 7.8 ) and 30 in control ( C ; mean age = 52.7 ± 6.5 ) . The Phase II cardiac exercise program included three 45 - 60-min sessions per week for 12 weeks , and the enhancement of self-efficacy through educational sessions and the use of goal setting , modelling , and physiological feedback strategies . Both groups were comparable in their medical regimen , exercise capacity , and other measured variables pre-intervention . At baseline and after 12 weeks , exercise capacity was evaluated by exercise testing using the Bruce Protocol , self-efficacy was measured with the Cardiac Exercise Self Efficacy Index , and serum lipid values were measured . Results At the completion of the 12-week exercise program , the exercise capacity ( P<0.001 ) , total cholesterol ( P = 0.004 ) , triglycerides ( P = 0.048 ) , high-density lipoprotein-cholesterol ( P = 0.001 ) , low-density lipoprotein-cholesterol ( P = 0.039 ) , and self-efficacy ( P<0.001 ) of the HBCEP Group were significantly improved compared to the control group . Conclusion These results suggest that a first-time HBCEP in Turkey can be successful in having patients adhere to a prescribed exercise program and reduce risk factors . Enhanced self-efficacy may have mediated the improved behavioural outcomes AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care BACKGROUND Due to the existing controversies in literature about the potential benefits of resistance exercise training ( RT ) on arterial blood pressure ( BP ) at rest , and the lack of studies conducted with elderly hypertensive individuals , RT is seldom recommended as a non-pharmacological treatment for arterial hypertension . OBJECTIVE To verify the effect of progressive RT on BP , HR , and RPP in elderly women with controlled hypertension . METHODS 20 elderly women ( 66.8 + /- 5.6 years of age ) , with a sedentary lifestyle , monitored with anti-hypertensive medication , participated in a 12-week RT program ( resistance training group - RTG ) .  Twenty-six elderly women ( 65.3 + /- 3.4 years of age ) with controlled hypertension did not engage in physical exercise during the study period , and composed the control group . RESULTS After RT , there was a significant reduction in SBP , MBP , and DP values at rest . No significant drops in DBP and HR values at rest were observed after RT in both groups . The reduction in the  RTG  was 10.5 mmHg , 6.2 mmHg , and 2218.6 mmHg x bpm for SBP , MBP , and RPP , respectively . CONCLUSION Progressive RT reduced SBP , MBP , and RPP values at rest of hypertensive elderly women who were on anti-hypertensive treatment The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating Background Cardiovascular disease is a major cause of morbidity/mortality in non-developed countries . Reports of the effects of non-pharmacological interventions on global cardiovascular risk in Latin American adults , however , are scarce . Objective To compare the change in global cardiovascular risk induced by a tailored , Adult Treatment Panel-III compliant nutrition program versus the same program with addition of supervised , regular physical activity in Colombian adults . Design The study was a r and omized , controlled trial . Methods Seventy-five Colombian patients aged 40–70 years and with Framingham-estimated global cardiovascular risk of 1 % or higher were r and omly assigned to a nutritional intervention program or a combined nutritional intervention-physical exercise program for 16 weeks . Patients underwent medical and anthropometric evaluation , bioelectrical impedance , lipid profile and Framingham global cardiovascular risk determination at baseline and at the end of follow-up . Results The groups were comparable at baseline ; 21 persons in the nutritional intervention program group and 27 in the nutritional intervention-physical exercise program group completed the follow-up . Global cardiovascular risk modification ( mean ± SE ) was −2.04 ± 1.1 absolute percentage points ( relative reduction 19.6 % ) in the nutritional intervention-physical exercise program group , compared with 0.23 ± 0.9 ( relative increase 2.8 % ) in the nutritional intervention program group . Mean difference in global cardiovascular risk modification between groups reached borderline statistical significance in ANCOVA ( P = 0.054 ) . Reductions in systolic and diastolic blood pressure , waist circumference and low-density lipoprotein cholesterol were similar , but the nutritional intervention-physical exercise program group achieved significantly greater improvements in body weight , body mass index , percentage body fat and high-density lipoprotein cholesterol . Conclusions Our data suggest that a structured nutritional intervention-physical exercise program is more efficacious than a nutritional intervention program in the reduction of global cardiovascular risk and cardiovascular risk factors , in only 16 weeks OBJECTIVE Assess the influence of physical activity on the blood pressure of hypertensive elderly patients on non-pharmacological treatment ( NPT ) .  METHODS The authors studied men and women , over 60 years , with stage I hypertension who were not using antihypertensive medication . These patients had been r and omly allocated to one of two groups : Control Group ( CG ) - oriented to NPT ; and Study Group ( SG ) - NPT and a program that included supervised physical activity consisting of 1-hour sessions , 3 times a week . Duration of the study was 6 months . Screening and follow-up tests every 3 months , at Visits 1 , 2 and 3 included a  clinical evaluation , ECG , a treadmill stress test , Ambulatory Blood Pressure Measurement ( ABPM ) and an Echocardiogram .  The authors used the Friedman test for the evolutionary analysis of the intra-groups means and Student 's t test to compare independent data between groups . RESULTS Twenty-four patients were r and omized in the SG ( 5 men ) and 21 in the CG ( 4 men ) . The 6-month follow-up period was completed by 22 patients in the SG and 13 in the CG . Blood pressures found by the ABPM in V1 , V2 and V3 were 134.2 + /-14.5 , 136.1 + /-9 and 143.7+/-13.9 mmHg for Systolic Blood Pressure in the CG ; and 135.6 + /-11.4 , 138.7 + /-12.2 and 133.9 + /-8.5 mmHg in the SG . For Diastolic Blood Pressure , values in the CG were 78.7+/-5.8 , 82.3+/-6.2 and 83.3 + /-9.2 mmHg ; and in the SG , 80.1 + /-6.8 , 81+/-6.6 and 80.8 + /-7.3 mmHg . CONCLUSION Programmed and supervised physical activity was more efficient for maintaining adequate blood pressure control in these elderly with stage I hypertension in the study group , when compared to the control group This study evaluated a structured and integrated intervention program on diabetes management in individuals with type 2 diabetes in Shanghai , China . Men and women with type 2 diabetes and body mass index > 23 kg/m2 were r and omized into a 24-week , prospect i ve , r and omized clinical trial . The Reference Group ( n=50 ) received diabetes education including diet and physical activity instruction only ; the Intervention Group ( n=100 ) received more intensive intervention , including diabetes education with frequent blood glucose monitoring , nutritional counseling , meal plans with diabetes-specific nutritional meal replacement , and weekly progress up date s with study staff . Major study assessment s were obtained at baseline , and after 12 and /or 24 weeks of intervention . The Intervention Group improved fasting blood glucose , insulin , systolic and diastolic blood pressures compared to Reference Group ( p < 0.05 ) . Importantly , HbA1c was lower ( p < 0.001 ) in the Intervention Group at 12 weeks ( -0.6 + /- 0.1 % ) and 24 weeks ( -0.8 + /- 0.1 % ) . Weight loss was modest , but significant differences were observed between groups ( p < 0.05 ) . Weight change from baseline after 12 and 24 weeks was -2.8 + /- 0.2 % and -3.7 + /- 0.3 % , respectively , in the Intervention Group vs -1.8 + /- 0.4 % and -2.5 + /- 0.4 % in the Reference Group . Additionally , waist and hip circumferences and waist : hip ratio decreased in the Intervention compared to the Reference Group ( p < 0.05 ) . In conclusion , this study demonstrates that Chinese men and women with type 2 diabetes following an integrated intervention program including diabetes education , frequent blood glucose monitoring and daily use of a diabetes-specific meal replacement , can achieve significant improvements in glycemic control and markers of cardiovascular health Objective To describe the secular changes in the prevalence , awareness , treatment and control of hypertension . Design Two independent cross-sectional population surveys using st and ardized methods conducted between the early 1980s and mid-1990s . Setting Twenty-four geographically defined population s of the WHO MONICA Project . Participants R and omly selected men and women aged 35–64 years . The total number of participants was 69 907 . Main outcome measures Two definitions of hypertension were used : 160/95 mmHg or above and 140/90 mmHg or above for systolic or diastolic blood pressure . Subjects on antihypertensive drug treatment were considered to be hypertensive regardless of their blood pressure . Treated subjects whose measured blood pressure level was less than 160/95 or 140/90 mmHg according to the two definitions , respectively , were considered to be adequately treated . Results The age-adjusted prevalence of hypertension decreased in most and increased in only a few population s. For both definitions of hypertension , the proportion of hypertensive subjects who were aware of their condition increased in three-quarters of the male population s and in two-thirds of the female population s. Furthermore , the proportion of hypertensive individuals on antihypertensive drug treatment increased in three-quarters of the population s. In the final survey , hypertension tended to be better treated and controlled in women than in men . Nevertheless , a large proportion of patients receiving antihypertensive drug therapy still had inadequately controlled blood pressure levels . Conclusion Although awareness and treatment of hypertension according to the data obtained during the late 1980s to the mid-1990s increased in several population s , the effectiveness of antihypertensive treatment showed the continuing need for improvements To determine the effectiveness of a yoga program on blood pressure and stress , a group of hypertensive patients in Thail and were studied , with the experimental group showing significantly decreased mean stress scores and blood pressure , heart rate , and body mass index levels compared with the control group . Further studies are suggested to determine the effects of yoga on hypertension in Thail and Context Observational studies suggest that higher intake of vegetable protein is associated with lower blood pressures . Contribution This double-blind trial from China r and omly assigned 302 adults with high-normal or mildly elevated blood pressures ( diastolic blood pressure of 80 to 99 mm Hg , systolic blood pressure of 130 to 159 mm Hg , or both ) to daily cookies containing 40 g of either soybean protein or complex carbohydrates . At 12 weeks , soybean cookies reduced diastolic and systolic blood pressure values by about 3 to 4 mm Hg more than did the carbohydrate cookies . Caution s The follow-up duration was short . Implication s Soybean protein supplementation might help lower blood pressure in some people . The Editors Hypertension has become a global public health challenge , affecting approximately 50 million individuals in the United States and 1 billion individuals worldwide ( 1 , 2 ) . The prevalence of hypertension has increased dramatically in developing countries during the past several decades ( 1 , 3 ) and has increased slightly in the United States according to a recent national survey ( 4 ) . Hypertension is not only very common but is also an important major modifiable risk factor for cardiovascular disease , stroke , and chronic kidney disease ( 5 - 7 ) . Lifestyle modification , including nutritional intervention , provides an important approach for preventing and treating hypertension ( 2 , 8) . Clinical trials have documented that weight loss , exercise , alcohol restriction , sodium reduction , and potassium supplementation reduce blood pressure in both hypertensive and prehypertensive persons ( 2 , 8) . The effect of dietary macronutrients on blood pressure has not been well studied , although clinical trials indicate that diets rich in fruits , vegetables , and low-fat dairy products and with reduced saturated and total fat ( Dietary Approaches to Stop Hypertension [ DASH ] diet ) lower blood pressure ( 9 ) . Several epidemiologic studies have observed an inverse relationship between dietary protein intake and blood pressure ( 10 - 14 ) . The few clinical trials that examined the effect of an increased intake of dietary protein on blood pressure produced conflicting results ( 10 , 15 , 16 ) . In most of these trials , change in blood pressure was not the primary outcome of interest , the sample size was small , and only a single blood pressure measurement was obtained at the baseline and termination visits ( 10 ) . We conducted a r and omized , double-blind , controlled multicenter trial to test the effect of soybean protein supplementation on systolic and diastolic blood pressure among individuals with prehypertension or stage 1 hypertension in 3 sample s of community residents in the People 's Republic of China . Methods Our study was a r and omized , double-blind , complex carbohydratecontrolled multicenter clinical trial design ed to test the efficacy of 40 g of isolated soybean protein supplementation per day in lowering systolic and diastolic blood pressure  among individuals with prehypertension or stage 1 hypertension . Three clinical centers in the People 's Republic of China , located in Beijing , Xiulo ( Hebei province ) , and Wuhan ( Hubei province ) , participated in the trial . Demographic characteristics and lifestyle , including dietary habits , were similar in the 3 communities . In Beijing , the clinical center used a 2 2 factorial design to assign the study participants to soybean protein and potassium ( 60 mmol/d ) interventions ( 17 ) . The other 2 centers used a 2-group parallel design to assign the study participants to soybean protein supplements or a complex carbohydrate control . Investigators obtained informed consent before the initial screening visit and before r and omization . The institutional review boards at the Tulane University Health Sciences Center and the Cardiovascular Institute of the Chinese Academy of Medical Sciences approved the protocol . Study Participants Trial participants were men and women 35 to 65 years of age who had an average systolic blood pressure of 130 to 159 mm Hg , diastolic blood pressure of 80 to 99 mm Hg , or both based on an average of 9 readings ( 3 observations at each of 3 screening visits ) . The criteria for exclusion were self-reported use of antihypertensive medications in the previous 2 months ; a history of cardiovascular disease , diabetes mellitus , cancer , chronic obstructive pulmonary disease , psychiatric disease , or any other serious life-threatening illness that required regular medical treatment ; serum creatinine level of 150.3 mol/L or greater ( 1.7 mg/dL ) at the screening examination ; or alcohol intake of 21 drinks or more per week or at least 40 g/d . We also excluded women who were pregnant or who intended to become pregnant during the study . The study sites conducted community-based blood pressure prescreening to recruit the trial participants . We invited 862 persons who met blood pressure and other criteria at prescreening and who were willing to participate in the trial to the study clinics for screening visits . Of them , 302 persons met all eligibility criteria and were r and omly assigned ( Figure 1 ) . Of the 302 trial participants , 150 were recruited from Beijing , 84 were recruited from Hebei province , and 68 were recruited from Hubei province . Figure 1 . Study participant flow chart . Intervention We r and omly allocated 150 study participants to soybean protein supplementation and 152 study participants to the control group by using a computer-generated scheme . We stratified the r and omization by clinical site and used a block size of 4 . We also stratified the r and omization by potassium supplementation allocation at the Beijing clinical site , result ing in an equal proportion of study participants receiving potassium intervention in the  soybean protein supplement group ( 37 of 74 participants ) and the  control group ( 38 of 76 participants ) . An effect of an interaction between soybean protein and potassium supplementation on blood pressure was not evident . The r and omization assignment schedule was concealed in an ordered set of sealed envelopes , which were opened only after the study coordinator had confirmed a participant 's eligibility . Apart from the study coordinator , all research personnel , including the blood pressure technicians , and the study participants were unaware of treatment assignment . Study participants who were assigned to the intervention group received 40 g of isolated soybean protein supplement per day in cookies for 12 weeks , while those in the control group received 40 g of complex carbohydrate from wheat in cookies during the same period . The Sanjiang Food Company ( Heilongjiang province , People 's Republic of China ) provided the isolated soybean protein supplements . The soybean protein and control cookies were prepared central ly in Beijing and had the same appearance and taste . The daily nutritional content of the cookies was similar for those in the soybean protein supplement group and the control group , except for dietary protein and carbohydrate content : total energy ( 594.0 kcal vs. 577.1 kcal ) , protein ( 49.0 g vs. 12.9 g ) , carbohydrate ( 64.8 g vs. 95.3 g ) , fat ( 15.4 g vs. 16.1 g ) , saturated fat ( 2.4 g vs. 2.6 g ) , monounsaturated fat ( 6.2 g vs. 6.3 g ) , polyunsaturated fat ( 7.0 g vs. 7.2 g ) , and sodium ( 145.3 mg vs. 145.8 mg ) . The Food Science and Human Nutrition Laboratory of Iowa State University , Ames , Iowa , and Ralston Analytical Laboratories , St. Louis , Missouri , measured isoflavones in duplicate . The measurements were almost the same between the 2 laboratories , and we report the average . The daily portion of the soybean protein cookies contained 76.4 mg of total isoflavone , 44.9 mg of genistein , 26.5 mg of daidzein , and 4.9 mg of glycitein . During the intervention , a study dietitian instructed study participants to reduce other food intake so that the total energy intake would be constant during the course of the trial . Most study participants consumed study cookies in place of their usual breakfast , and a few study participants consumed study cookies in place of their usual lunch . Participants were also instructed to maintain their usual level of physical activity , alcohol intake , and dietary sodium intake . We monitored each participant 's body weight biweekly during the study and provided dietary consultation when we observed more than a 2-kg weight gain . The study participants returned unconsumed cookies at their 6- and 12-week follow-up visits after r and omization . The study coordinator counted the number of cookies returned , and we used this to assess the participants ' adherence to their assigned intervention . Measurements We collected information on demographic characteristics , medical history , medication use , alcohol consumption , and physical activity at baseline . Study staff members who were trained and certified in the use of Hawksley r and om-zero sphygmomanometers measured blood pressure . Blood pressure readings were taken from the right arm with appropriately sized cuffs after the participant had been seated quietly for 5 minutes . We obtained 3 blood pressure measurements at each of the 3 screening visits before intervention and at the follow-up visits at 6 and 12 weeks after r and omization . We measured weight , height , and waist circumference by using a st and ard protocol and calculated body mass index as kg/m2 . Experienced and trained research staff conducted a 24-hour dietary recall at the screening visit , the 6-week visit , and the 12-week visit . We calculated dietary nutrient intake on the basis of the China Food Composition Tables ( 18 ) . We obtained a 24-hour urinary specimen at the screening visit , the 6-week visit , and the 12-week visit to measure urinary excretion of sodium and potassium . Study staff assessed the presence of side effects ( 15 items ) by using a st and ard question naire at the 12-week follow-up visit . Statistical Analysis We design ed our trial to provide more than 80 % statistical power to detect a 3.0 mm Hg reduction in systolic blood pressure and a 2.0 mm Hg AIM The aim of this study was to determine the effect of anti-hypertensive patient-oriented education and in-home monitoring for medication adherence and management of hypertension in a primary care setting , by providing education on healthy lifestyle behaviours and medication adherence . BACKGROUND Hypertension is the third most common cause of death worldwide . Prevalence of hypertension in Turkey is approximately 30 % in the general population and 45 - 50 % in population over 50 . DESIGN R and omised controlled study . METHODS This study conducted in Turkey used a study group comprised of 120 subjects ( 40 Group A , 40 Group B , 40 controls ) , all previously diagnosed with hypertension and who started medication therapy at least one year prior to start of study . The study was conducted between February-November 2006 at public primary health care facilities and homes of the study participants . Participants in Group A and B received a total of six monthly education sessions , four times during clinic visits and two home visits . Medication adherence education for Groups A and B and education about healthy lifestyle behaviours for Group B were administered in a structured and individualised format . The control group was routinely monitored in health care facilities . RESULTS Healthy lifestyle behaviours and perception of self-efficacy regarding medication adherence showed improvement after education sessions in Groups A and B. Systolic and diastolic blood pressures of subjects in Group A and B showed a significant decrease compared with those of the control group ; the blood pressure decrease in Group B was greater than in Group A. CONCLUSION Nurses play an important role in uncontrolled hypertension detection and can improve medication adherence and healthy lifestyle behaviours . RELEVANCE TO CLINICAL PRACTICE Patient education medication adherence alone and in combination with healthy lifestyle behaviour teaching is an effective tool for blood pressure reduction in the hypertensive population in primary health care setting
target: Subgroup analyses showed smaller sample s reporting larger effect sizes ; intervention lasting less than 6 months showed larger effect sizes and intention-to-treat analysis showed smaller effect sizes Lifestyle interventions may be of value in preventing and reducing blood pressure in LMICs .
background: Despite the overwhelming evidence supporting the effectiveness of antihypertensive medication , hypertension remains poorly controlled in low and middle-income countries ( LMICs ) .