1.
Financial incentives for hypertension control: rationale and study design.
Zheng, L, Wang, Y, Liu, S, Zheng, R, Pei, D, Sun, Y, Sun, Z
Trials. 2020;(1):134
Abstract
BACKGROUND Even though the effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention of hypertension and its complications have been demonstrated in randomized controlled trials, the benefits of adhering to these treatments have not been popularized among the general public. Studies suggest that incentive approaches based on behavioral economic concepts can improve patients' adherence to treatment. Therefore, we aimed to test whether financial incentives will reduce the blood pressure (BP) of hypertensive patients in China. METHODS/DESIGN This is a multicenter, randomized controlled trial with two parallel arms. A total of 400 participants from six cities in the Liaoning and Shanxi provinces of China are block-randomized into intervention and control group with a 1:1 ratio. Patients in the control group will receive interactive management of mobile devices, including patient education and communication. Patients in the intervention group will receive financial incentives in addition to interactive management of mobile devices, conditional on them achieving their antihypertensive goals or hypertension control. Masking the arm allocation will be precluded by the behavioral nature of the intervention and investigators of BP measurement and statistics are masked to clinic assignment. The primary outcome is net change in systolic BP (SBP) from baseline to month 12 between the intervention and control groups. The secondary outcomes are net change in diastolic BP (DBP), BP control, change in medication adherence and lifestyle, and cost-effectiveness. DISCUSSION This trial will determine whether financial incentives will improve hypertension control and generate necessary data for controlling hypertension and concomitant cardiovascular diseases among hypertensive patients in China. TRIAL REGISTRATION ISRCTN13467677. Registered on 16 May 2019.
2.
Whole- and refined-grain intakes and the risk of hypertension in women.
Wang, L, Gaziano, JM, Liu, S, Manson, JE, Buring, JE, Sesso, HD
The American journal of clinical nutrition. 2007;(2):472-9
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Abstract
BACKGROUND Prospective studies linking whole- and refined-grain intakes with the risk of hypertension, a major cardiovascular disease risk factor, remain limited. OBJECTIVE We aimed to determine whether baseline intake of whole or refined grains is associated with subsequent development of hypertension. DESIGN We conducted a prospective cohort study in 28 926 female US health professionals aged >or=45 y who were free of baseline cardiovascular disease, cancer, and hypertension in 1992. Baseline whole- and refined-grain intakes were assessed from semiquantitative food-frequency questionnaires. We identified 8722 incident cases of hypertension from annual questionnaires during 10 y of follow-up. RESULTS After adjustment for known hypertension risk factors, the relative risks (RRs) (and 95% CIs) of incident hypertension were 1.00 (reference), 0.96 (0.89, 1.03), 0.95 (0.88, 1.02), 0.92 (0.85, 0.99), and 0.89 (0.82, 0.97) across the increasing quintiles of baseline whole-grain intake (P for trend = 0.007). When functional cutoffs were used, women who consumed 0.5 to <1, 1 to <2, 2 to <4, and >or=4 whole-grain servings/d had multivariate RRs (95% CIs) of 0.93 (0.87, 1.00), 0.93 (0.87, 0.99), 0.92 (0.85, 0.99), and 0.77 (0.66, 0.89), respectively, compared with those who consumed <0.5 whole-grain servings/d. In contrast, refined-grain intake was not associated with the risk of hypertension. The multivariate RRs of hypertension across the increasing quintiles of refined-grain intake were 1.00, 0.97, 0.94, 0.99, and 0.97 (P for trend = 0.80). CONCLUSION Higher whole-grain intake was associated with a reduced risk of hypertension in middle-aged and older women, which suggests a potential role for increasing whole-grain intake in the primary prevention of hypertension and its cardiovascular complications.