ENLIGHTEN-ing a Population

By Damon Williams

November 25, 2019

The greatest contributor to premature and preventable death is hypertension, which is a risk factor for heart attack and stroke. Thirty-one percent of the global population suffers from hypertension, with incidences only increasing. Obesity and being overweight, primarily caused by a sedentary lifestyle and “western diet,” contributes to hypertension in patients. Worldwide efforts are being made by physicians to combat the global epidemic of obesity by encouraging all age groups to make healthy eating decisions and to be more active. However, the problem seems to be increasing at alarming rates. Although it may be common knowledge to some, many individuals around the world are not aware of how their diet and lifestyle are adversely affecting their overall health. Sometimes this is due to lack of proper health education, which may be outside of an individual’s control, such as a poor quality of local healthcare or poverty. It is important to address the well-being of these demographics, as they are often overlooked or simply forgotten.

In a paper recently published in the Journal of Community Health, a team of researchers outlined the effectiveness of a monthly lifestyle education program on increasing the cardiovascular health of pre-hypertensive adults in a low-income urban setting. This study was led by first author Julieta Gabilola, MD, Clinical Professor of Medicine at Stanford University and senior author Latha Palaniappan, MD, MS, Professor of Medicine at Stanford University. The ENLIGHTEN study (the EffeciveNess of LIfestyle with diet and physical education proGram among prehypertensives and stage 1 HyperTENsives in an urban community setting) is an intervention study that compares select health metrics of a group of individuals that was assigned to either an intervention or attention-control group. The intervention group was exposed to lectures on cardiovascular disease, as well as organized lectures on diet and exercise. The attention-control group, however, only received lectures on non-cardiovascular topics, only receiving the advice that a healthy diet and exercise are important. The aim was to determine if educational programs alone could be used as a resource for improving hypertension levels and, ultimately, cardiovascular health.

To test their question, the researchers had 156 participants in Manila, Philippines, who were assigned to either the attention-control group or the intervention group, and who participated for the full 6 months. The primary outcome for the study was looking for blood pressure reduction, with secondary outcomes including waist circumference, total cholesterol, and fasting glucose, all measures associated with cardiovascular health. The researchers found that the monthly education sessions (intervention group) had profound positive effects on the health of the selected individuals. They noticed a statistically significant decrease in systolic blood pressure, BMI, waist circumference, total cholesterol, and glucose levels. Importantly, these findings show the feasibility of implementing lifestyle interventions and education programs in the Philippines and other developing countries with limited health care resources in improving cardiovascular health.

Other Stanford University authors are Kyle Feliciano, Ariadna Garcia, Haley Hedlin, and Mark Cullen. Other authors are Dante Morales, Olive Quizon, Ronald Ian Cadiz, Roberto Ruiz, Christine Joy Aguatis, and Teresita Mararac at Manila Doctors Hospital, Manila, Philippines, and Jenssy Rojina from Oregon Health and Science University School of Medicine. Funding was provided by NIH UL1 TR001085 and ABC’s for Global Health.

Julieta Gabilola, MD

Latha Palaniappan, MD, MS