The EffectiveNess of LIfestyle with Diet and Physical Activity Education ProGram Among Prehypertensives and Stage 1 HyperTENsives in an Urban Community Setting (ENLIGHTEN) Study

The ENLIGHTEN Study, led by first author Julieta Gabiola, MD, and senior author Latha Palaniappan, MD, MS,  is an intervention study that compares health metrics of a group of individuals that was assigned to either an intervention or attention-control group. The intervention group received lectures on cardiovascular disease, as well as on diet and exercise. The attention-control group only received lectures on non-cardiovascular topics, and received the advice that a healthy diet and exercise are important. The aim of this study was to determine if educational programs alone could be used as a resource for improving hypertension levels and, as a result, cardiovascular health.

Objective: To determine the effectiveness of a monthly lifestyle education program, which included advice on nutritional changes and physical activity enhancement in the reduction of blood pressure and selected biochemical and anthropometric parameters among pre-hypertensive and stage 1 hypertensive participants in Manila, Philippines.

Methods: Participants resided in two barangays (districts), in Manila, Philippines, and each barangay was assigned to either the intervention or attention-control group. The intervention group received monthly lectures on cardiovascular disease and organized classes on diet, and exercise, while the attention-control group received monthly lectures on non-cardiovascular topics, with verbal advice that healthy diet and exercise are important. The primary outcome was systolic blood pressure, with secondary outcomes of BMI, waist circumference, and laboratory measures. Linear mixed effects models with an interaction between intervention group and time were used to estimate the 6-month change in each group.

Results: At 6 months, systolic blood pressure was lower in the intervention group compared to the attention-control group (-12.7 mmHg (95% CI [-14.5, -10.9]) vs. -0.24 mmHg (95% CI [-1.87, 1.43]), p-value<0.001). Waist circumference (p<0.001), BMI (p<0.001), and total cholesterol (p=0.049) were also lower. However, no statistically significant difference in fasting glucose was observed between the two groups (p=0.740).

Conclusion: This study showed that participants receiving a non-pharmacological intervention, specifically a low-cost diet and active lifestyle education program, experienced a greater decrease in blood pressure, BMI, waist circumference, and total cholesterol than the attention-control group. Educational programs such as in ENLIGHTEN show promise for a developing country with limited resources to improve hypertension levels, and ultimately cardiovascular health. ENLIGHTEN deserves further study in randomized trials.

Interested in learning more? Click here to read the recently published paper in the Journal of Community Health and here to read an article by the Stanford Cardiovascular Institute.