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Sequential counselling that targeted individual health behaviours did not differ from simultaneous counselling that targeted multiple behaviours

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D J Hyman

Correspondence to: Dr D J Hyman, Baylor College of Medicine, Houston, TX, USA;


In patients with multiple behavioural risk factors for cardiovascular disease, is sequential counselling (SQC) that targets 1 behaviour at a time more effective than simultaneous counselling (SMC) that targets multiple behaviours?



randomised controlled trial (RCT).





Follow-up period:

18 months.


2 primary care clinics in the southwestern US.


289 African-American patients 45–65 years of age (mean age 53 y, 67% women) who had hypertension, currently smoked (cotinine >40 ng/ml for 24 h urine sample or reported smoking ⩾5 cigarettes/d for the past wk), had a 24-hour urine sodium level >100 mEq/l per day, and did not exercise regularly (ie, ⩾3 times/wk for ⩾30 min, hard enough to work up a sweat). Exclusion criteria included systolic blood pressure (BP) >180 mm Hg or diastolic BP >110 mm Hg, type 1 diabetes …

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  • Source of funding: National Heart, Lung, and Blood Institute.