Two Self-management Interventions to Improve Hypertension Control: A Randomized Trial.
Bosworth, Hayden B. PhD; Olsen, Maren K. PhD; Grubber, Janet M. MSPH; Neary, Alice M. RN; Orr, Melinda M. MEd; Powers, Benjamin J. MD; Adams, Martha B. MD; Svetkey, Laura P. MD; Reed, Shelby D. PhD; Li, Yanhong MS; Dolor, Rowena J. MD, MHS; Oddone, Eugene Z. MD, MHS
[Article] Annals of Internal Medicine. 151(10):687-695, November 17, 2009.

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Background: Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control.

Objective: To compare 2 self-management interventions for improving BP control among hypertensive patients.

Design: A 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058)

Setting: 2 university-affiliated primary care clinics.

Patients: 636 hypertensive patients.

Intervention: 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.

Measurements: The primary outcome was BP control at 6-month intervals over 24 months.

Results: 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, -4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, -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, -2.2 to 3.4 mm Hg) for the behavioral intervention group, -0.6 mm Hg (CI, -3.6 to 2.3 mm Hg) for the BP monitoring group, and -3.9 mm Hg (CI, -6.9 to -0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP.

Limitation: 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.

Conclusion: Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care.

Primary Funding Source: National Heart, Lung, and Blood Institute; Pfizer Foundation Health Communication Initiative; and the American Heart Association.

(C) 2009 American College of Physicians