Hayden B. Bosworth, PhD; Maren K. Olsen, PhD; Janet M. Grubber, MSPH; Alice M. Neary, RN; Melinda M. Orr, MEd; Benjamin J. Powers, MD; Martha B. Adams, MD; Laura P. Svetkey, MD; Shelby D. Reed, PhD; Yanhong Li, MS; Rowena J. Dolor, MD, MHS; Eugene Z. Oddone, MD, MHS
Bosworth HB, Olsen MK, Grubber JM, Neary AM, Orr MM, Powers BJ, et al. Two Self-management Interventions to Improve Hypertension Control: A Randomized Trial. Ann Intern Med. 2009;151:687-695. doi: 10.7326/0000605-200911170-00148
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Published: Ann Intern Med. 2009;151(10):687-695.
Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control.
To compare 2 self-management interventions for improving BP control among hypertensive patients.
A 2Â Ã—Â 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058)
2 university-affiliated primary care clinics.
636 hypertensive patients.
A centralized, blinded, and stratified randomization algorithm was used to randomly assign eligible patients to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring.
The primary outcome was BP control at 6-month intervals over 24 months.
475 patients (75%) completed the 24-month BP follow-up. At 24 months, improvements in the proportion of patients with BP control relative to the usual care group were 4.3% (95% CI, âˆ’4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, âˆ’1.9% to 17.0%) in the home BP monitoring group, and 11.0% (CI, 1.9%, 19.8%) in the combined intervention group. Relative to usual care, the 24-month difference in systolic BP was 0.6 mm Hg (CI, âˆ’2.2 to 3.4 mm Hg) for the behavioral intervention group, âˆ’0.6 mm Hg (CI, âˆ’3.6 to 2.3 mm Hg) for the BP monitoring group, and âˆ’3.9 mm Hg (CI, âˆ’6.9 to âˆ’0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP.
Changes in medication use and diet were monitored only in intervention participants; 24-month outcome data were missing for 25% of participants, BP control was adequate at baseline in 73% of participants, and the study setting was an academic health center.
Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care.
National Heart, Lung, and Blood Institute; Pfizer Foundation Health Communication Initiative; and the American Heart Association.
Can self-management interventions help improve blood pressure control in hypertensive patients?
In this trial, 636 patients with hypertension were randomly assigned to receive usual care; a telephone-delivered, nurse-administered behavioral self-management intervention; home blood pressure self-monitoring; or both of the latter 2 interventions. Compared with usual care, the adjusted improvement in the proportion of patients with blood pressure control at 24 months was 4.3% for the behavioral intervention group, 7.6% for the blood pressure monitoring group, and 11.0% for the combined intervention group.
Patients were recruited from 2 university-affiliated clinics, and most (73%) already had reasonable blood pressure control at trial entry.
BP = blood pressure.
* No longer receiving care at Duke clinics, receiving dialysis, received an organ transplant, residing in a nursing home or receiving home health care, had no telephone, or had pulmonary hypertension.
Bars represent 95% CIs. BP = blood pressure. Top. Estimated proportion of patients with BP control. Estimates are marginalized probabilities from a logistic mixed-effects regression model (22). The model-estimated intrapatient correlation was 0.56. The 95% CIs at 12 and 24 months were derived from 1000 bootstrap samples. Middle. Estimated mean systolic BP. Estimates are based on a general linear model with an unstructured covariance matrix. The model-estimated correlation between time points ranged from 0.41 (baseline and 24 months) to 0.58 (months 6 and 12). Bottom. Estimated mean diastolic BP. Estimates are based on a general linear model with an unstructured covariance matrix. The model-estimated correlation between time points ranged from 0.54 (baseline and 24 months) to 0.66 (baseline and 6 months).
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Cardiology, Coronary Risk Factors, Hypertension, Nephrology, Prevention/Screening.
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