BACKGROUND: Preventive electronic (e)-counselling has been shown to reduce cardiovascular risk factors. However, heterogeneity in outcomes is commonly reported due to differences in e-protocols. We incorporated key features of an established behavioural therapy, motivational interviewing, to help standardize e-counselling in order to reduce blood pressure in patients with hypertension. METHODS: Subjects (n = 387, mean age 56 years, 59% female, 72% taking >= 1 antihypertensive drug) were diagnosed with stage 1 or 2 hypertension. Subjects were randomized to a 4-month protocol of e-counselling (beta version of the "Blood Pressure Action Plan", Heart and Stroke Foundation of Canada) versus waitlist control (general e-information on heart-healthy living). Outcomes were systolic, diastolic, and pulse pressures, and total lipoprotein cholesterol after treatment. RESULTS: Intention to treat analysis did not find a significant group difference in outcomes due to contamination across the 2 arms of this trial. However, per protocol analysis indicated that subjects receiving >= 8 e-counselling messages (a priori therapeutic dose) versus 0 e-counselling messages (control) demonstrated greater reduction in systolic blood pressure (mean -8.9 mmHg; 95% confidence interval (CI) -11.5 to -6.4 versus -5.0 mmHg; 95% CI -6.7 to -3.3, p = 0.03), pulse pressure (-6.1 mmHg; 95% CI -8.1 to -4.1 versus -3.1 mmHg; 95% CI -4.3 to -1.8, p = 0.02) and total cholesterol (-0.24 mmol/L; 95% CI -0.43 to -0.06 versus 0.05 mmol/L; 95% CI -0.06 to 0.16, p = 0.03), but not diastolic blood pressure. CONCLUSIONS: These findings support the merit of evaluating whether e-counselling can improve blood pressure control and reduce cardiovascular risk over the long-term.

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