The effect of a reminder diary on risk factors in patients with chronic hypertension attending a clinic at a hospital in Johannesburg, South Africa

BACKGROUND: Poor adherence to lifestyle interventions and medication-taking is problematic, and there is some evidence that a diary may be useful in facilitating patients’ adherence to lifestyle modification in chronic disease. OBJECTIVES: To compare changes in blood pressure, waist–hip ratio, body mass index, blood levels and exercise capacity between two experimental groups and one control group (CG) after a six month intervention, and at a further three month follow up. METHOD: This was a longitudinal randomised control trial. All three groups underwent usual treatment. In addition, Experimental group one (EG1) received the diary as well as a once-a-month telephone call and Experimental group two (EG2) received only a once-a-month telephone call. Changes in measurements were established using an ANCOVA. The significance of the study was set at p = 0.05. RESULTS: The added intervention of the diary had no direct effect on blood pressure change greater than that achieved by the appropriate medication. All three groups showed a clinically significant drop in both systolic and diastolic blood pressure to accepted norms. There were marginal differences in EG1 for waist–hip ratios (p = 0.06) at six months. There were significant low density lipoprotein (LDL) reductions in both EG1 and EG2 at nine months compared with the CG (p = 0.02) Walking distances improved minimally in both EG1 and EG2. CONCLUSION: The diary and telephone interventions showed some positive trends toward improvements in risk factors of patients with chronic hypertension.