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Two self-management interventions to improve hypertension control: a randomized trial.

Hayden B Bosworth1, Maren K Olsen, Janet M Grubber

  • 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Center for Aging and Human Development, Duke Hypertension Center, and Duke Clinical Research Institute, Duke University, Durham, North Carolina 27703, USA. hayden.bosworth@duke.edu

Annals of Internal Medicine
|November 19, 2009
PubMed
Summary

A combined intervention of home blood pressure (BP) monitoring and behavioral counseling significantly improved BP control in hypertensive patients over 24 months. This approach offers a promising strategy for managing hypertension effectively.

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Area of Science:

  • Cardiovascular Medicine
  • Health Behavior Interventions
  • Primary Care Research

Background:

  • Hypertension affects a significant portion of the US population, with fewer than 40% achieving adequate blood pressure (BP) control.
  • Effective self-management strategies are crucial for improving BP control rates.

Purpose of the Study:

  • To compare the efficacy of two self-management interventions against usual care for improving BP control in hypertensive patients.
  • To evaluate the impact of behavioral interventions and home BP monitoring on hypertension management.

Main Methods:

  • A 2x2 randomized trial involving 636 hypertensive patients across two primary care clinics.
  • Interventions included a tailored, nurse-administered telephone behavioral program and/or home BP monitoring (3 times weekly).
  • Patients were stratified by enrollment site and health literacy, with a 24-month follow-up period.

Main Results:

  • The combined intervention group showed the greatest improvement in BP control at 24 months (11.0% increase vs. usual care).
  • The combined intervention resulted in a significant reduction in systolic BP (-3.9 mm Hg) and diastolic BP compared to usual care.
  • Improvements were observed in the proportion of patients achieving BP control, with similar trends for systolic and diastolic BP.

Conclusions:

  • A combined approach of home BP monitoring and a tailored behavioral telephone intervention effectively improves BP control in hypertensive patients.
  • This integrated self-management strategy demonstrates significant benefits for systolic and diastolic BP at 24 months.
  • The findings support the use of combined interventions for enhanced hypertension self-management in primary care settings.