**1. Introduction**

The implementation of strategies that effectively promote the prevention and treatment of the obesity–hypertension phenotype is urgently required. These must have the clinical objectives of controlling blood pressure (BP) and body composition (fat loss and muscle

**Citation:** Múzquiz-Barberá, P.; Ruiz-Cortés, M.; Herrero, R.; Vara, M.D.; Escrivá-Martínez, T.; Carcelén, R.; Baños, R.M.; Rodilla, E.; Lisón, J.F. The Impact of a Web-Based Lifestyle Educational Program ('Living Better') Reintervention on Hypertensive Overweight or Obese Patients. *Nutrients* **2022**, *14*, 2235. https:// doi.org/10.3390/nu14112235

Academic Editors: Abeer M. Mahmoud and Shane Phillips

Received: 2 May 2022 Accepted: 25 May 2022 Published: 27 May 2022

**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

mass gain), improving cardiorespiratory fitness and functional capacity, and reducing polypharmacy [1]. In this sense, the most recent clinical guidelines on hypertension (HTN) and obesity (OB) [2–4] agree that promoting a healthy lifestyle should be the first step considered in obese patients with HTN. To achieve these changes, the process must be based on two fundamental pillars: regular physical activity (PA) and healthy eating behavior [5].

PA has been defined as "any bodily movement produced by skeletal muscles that results in energy expenditure" [6]. Specifically, exercise is described as "a subset of physical activity that is planned, structured, and repetitive and has as a final or an immediate objective the improvement of maintenance of physical fitness" [6]. At present, exercise is considered a polypill for the prevention and treatment of numerous health conditions, including chronic diseases such as OB and HTN [5]. Thus, it has been shown that regularly engaging in sustained PA over time is essential to maintain long-term weight loss [1,7]. However, even though moderate weight reductions (~1–3 kg) can be achieved with exercise programs without dietary modifications, the combination of regular PA and healthy eating behaviors, including a decrease in caloric intake [8], is the most effective strategy to address weight loss and its maintenance [1]. Of note, one of the most successful dietary interventions described in the academic literature was from the Prevención con Dieta Mediterránea (PREDIMED) study, and was precisely administered in a Spanish population at high risk for cardiovascular events [9].

The recent academic literature indicates that there was a dramatic decrease in PA during the COVID-19 pandemic, which was especially worrisome in patients with associated metabolic conditions [10]. In hypertensive older adults, unhealthy changes manifested as a reduction in PA and increased sedentary behavior [11]. Other research suggested that unhealthy eating patterns intensified among high-risk patient groups during the pandemic [12]. Similarly, a related study showed that obese individuals spent less time engaging in PA, exercised less intensely, and were more anxious about eating during the pandemic, all of which can make body weight control more difficult [13].

In this context, online interventions can reach different populations, overcoming barriers and limitations, and they represent effective strategies for the prevention and/or treatment of multiple health conditions. However, to date, only four studies [14–17] have analyzed the effectiveness of such treatments in patients with both health conditions—that is, in individuals presenting an OB-HTN phenotype. Of note, none of the four studies performed in this specific area, and only one in non-hypertensive obese adults [18], followed up with patients who had completed an online educational intervention for at least 3 years. In addition, to the best of our knowledge, no research has yet analyzed the effects of a second intervention (reintervention) with an online intervention program in patients with OB, HTN, or any other type of cardiovascular disease.

Given all the above, in this current study, we set out to (1) understand the evolution at 3 years of a group of hypertensive overweight or obese individuals who had followed the 'Living Better' web-based program in 2018 [17]; (2) analyze the effects of completing this program a second time (reintervention) during the COVID-19 pandemic—3 years after the initial intervention—in terms of systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), number of antihypertensive drugs used, PA, eating behavior, and adherence to the Mediterranean diet.
