Lifestyle Coaching Versus Enhanced Pharmacotherapy for Blood Pressure Control in Black Adults with Persistent Uncontrolled Hypertension

The Shake, Rattle, & Roll study completed by Nguyen-Huynh et al. (2022) analyzes the effectiveness of lifestyle coaching and enhanced pharmacotherapy for black adults in the US with uncontrolled hypertension. The findings reveal that participants who received lifestyle coaching exhibited improved blood pressure control, and these outcomes persisted even up to 48 months post-intervention.

As discussed in this study, black adults in the US demonstrate a higher likelihood of experiencing cardiovascular disease and stroke compared to other ethnic groups. Therefore, it is crucial to identify strategies to reduce their risk of disease and achieve health outcomes that are more equitable with those of their white counterparts.
 
Given that black adults in the US are less likely to acquire satisfactory blood pressure (BP) control, the current study investigates various approaches that could lead to lasting satisfactory BP management. Participants were divided into three groups: those receiving a lifestyle coaching intervention (LC), individuals undergoing an enhanced pharmacotherapy monitoring protocol (EP), and a control group that received their usual care (UC). 
 
The LC group participated in up to 16 individual telephone coaching sessions with a lifestyle coach, with at least half of the participants attending six or more sessions. Included in the lifestyle coaching were motivational interviewing techniques wherein participants constructed personal goals, determined potential barriers to achieving those goals, and received education and resources that promote healthy lifestyle behaviours. The preeminent goals of the LC intervention were to lower salt intake, as recommended in the Dietary Approaches to Stop Hypertension Diet, and to increase agency in participants so that they could adopt positive lifestyle behaviours independently.  
 
The UC group received free BP check visits, which included measuring participants’ BP with a cuff and conducting medication reviews. Correspondingly, the EP group received additional BP visits, conducted by a research nurse coordinator and a pharmacist, to “optimize thiazide diuretic dosing, and to increase prescribing of spironolactone for resistant hypertension”.
 
The researchers observed that the LC group displayed significant improvements in blood pressure control in comparison to the UC and EP groups. In particular, receiving telephone-based lifestyle interventions that were culturally aligned (integrating culturally-relevant photographs, stories, and recipes), the use of motivational interviewing, and the emphasis on maintaining a low-salt diet, all supported the implementation of independent health-promoting behaviours that lasted even as long as three years following the coaching sessions. These behaviours resulted in sustained BP control, whereas only participating in multiple blood pressure visits or obtaining enhanced pharmacotherapy did not.
 
Conclusively, the importance of lifestyle coaching, or health coaching, should not be understated. Health coaches serve as catalysts for sustainable change, particularly among populations at risk for chronic conditions like hypertension. The findings from the Shake, Rattle, & Roll study highlight that personalized lifestyle coaching not only fosters immediate improvements in health indicators—such as blood pressure—but also equips participants with the tools and knowledge necessary for long-term self-management.

This empowerment is especially vital for black adults, who may face systemic barriers to healthcare access and resources. By integrating culturally relevant content and motivational interviewing techniques into the coaching process, health coaches help individuals navigate their unique challenges and reinforce positive behavior change.

​As demonstrated in this study, their role significantly enhances adherence to healthful practices, ultimately leading to healthier outcomes and improved quality of life. As healthcare systems evolve to focus more on personalized care approaches, the involvement of health coaches could become a cornerstone of effective chronic disease management, fostering both individual well-being and community health equity.

Source: https://pubmed.ncbi.nlm.nih.gov/35583869/