Two Self-management Interventions to Improve Hypertension Control

A Randomized Trial

  1. Hayden B. Bosworth, PhD;
  2. Maren K. Olsen, PhD;
  3. Janet M. Grubber, MSPH;
  4. Alice M. Neary, RN;
  5. Melinda M. Orr, MEd;
  6. Benjamin J. Powers, MD;
  7. Martha B. Adams, MD;
  8. Laura P. Svetkey, MD;
  9. Shelby D. Reed, PhD;
  10. Yanhong Li, MS;
  11. Rowena J. Dolor, MD, MHS; and
  12. Eugene Z. Oddone, MD, MHS
  1. From the Center 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.

Abstract

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 × 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.

Article and Author Information

  • Disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

  • Grant Support: By grant R01 HL070713 from the National Heart, Lung, and Blood Institute; a Pfizer Foundation Health Communication Initiative Award; and an Established Investigator Award from the American Heart Association (Dr. Bosworth).

  • Potential Conflicts of Interest: None disclosed.

  • Reproducible Research Statement: Study protocol and data set: Available from Dr. Bosworth (e-mail, hayden.bosworth{at}duke.edu). Statistical code: Available from Dr. Olsen (e-mail, maren.olsen{at}duke.edu).

  • Requests for Single Reprints: Hayden B. Bosworth, PhD, Center for Health Services Research in Primary Care, Duke University, 2424 Erwin Road, Hock Plaza, Durham, NC 27703; e-mail, hayden.bosworth{at}duke.edu.

  • Current Author Addresses: Drs. Bosworth and Powers and Ms. Neary: Center for Health Services Research in Primary Care, Duke University, 2424 Erwin Road, Hock Plaza, Durham, NC 27703.

  • Drs. Olsen and Oddone, Ms. Grubber, and Ms. Orr: Durham Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705.

  • Dr. Adams: Duke University Medical Center, Box 3230, Durham, NC 27710.

  • Dr. Svetkey: Duke Hypertension Center, Sarah W. Stedman Nutrition and Metabolism Center, 3475 Erwin Road, Suite 100, Durham, NC 27705.

  • Drs. Reed and Dolor and Ms. Li: Duke Clinical Research Institute, 2400 Pratt Street, Room 311, Durham, NC 27705.

  • Author Contributions: Conception and design: H.B. Bosworth, M.K. Olsen, M.M. Orr, M.B. Adams, L.P. Svetkey, E.Z. Oddone.

  • Analysis and interpretation of the data: H.B. Bosworth, M.K. Olsen, J.M. Grubber, L.P. Svetkey, S.D. Reed, Y. Li, E.Z. Oddone.

  • Drafting of the article: H.B. Bosworth, M.K. Olsen, J.M. Grubber, A.M. Neary, M.M. Orr, E.Z. Oddone.

  • Critical revision of the article for important intellectual content: H.B. Bosworth, M.K. Olsen, A.M. Neary, B.J. Powers, M.B. Adams, L.P. Svetkey, S.D. Reed, R.J. Dolor, E.Z. Oddone.

  • Final approval of the article: H.B. Bosworth, M.K. Olsen, M.M. Orr, L.P. Svetkey, S.D. Reed, Y. Li, R.J. Dolor, E.Z. Oddone.

  • Provision of study materials or patients: A.M. Neary, B.J. Powers, L.P. Svetkey.

  • Statistical expertise: H.B. Bosworth, M.K. Olsen, J.M. Grubber, Y. Li.

  • Obtaining of funding: H.B. Bosworth, M.K. Olsen, E.Z. Oddone.

  • Administrative, technical, or logistic support: H.B. Bosworth, M.M. Orr, M.B. Adams, R.J. Dolor, E.Z. Oddone.

  • Collection and assembly of data: J.M. Grubber, A.M. Neary, M.M. Orr, Y. Li.

« Previous | Next Article »Table of Contents

This Article

  1. Ann Intern Med November 17, 2009 vol. 151 no. 10 687-695
  1. » Abstract
  2. Figures
  3. Full Text
  4. Full Text (PDF)

Rapid Responses

  1. Submit a response
  2. No responses published

Current Issue

  1. February 2, 2010, 152 (3)
  1. Alert me to current issues