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Original Investigation
Health Care Reform
July 11, 2011

Home Blood Pressure Management and Improved Blood Pressure Control: Results From a Randomized Controlled Trial

Author Affiliations

Author Affiliations: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina (Drs Bosworth, Powers, Olsen, Van Houtven, Wang, and Oddone and Mss McCant, Grubber, Smith, Gentry, and Rose); Departments of Medicine, Division of General Internal Medicine (Drs Bosworth, Powers, Van Houtven, Wang, and Oddone and Mss Grubber and Smith) and Biostatistics and Bioinformatics (Dr Olsen), Duke University, Durham; and Veterans Affairs Palo Alto Health Care System and Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Palo Alto, California (Dr Goldstein).

Arch Intern Med. 2011;171(13):1173-1180. doi:10.1001/archinternmed.2011.276

Background To determine which of 3 interventions was most effective in improving blood pressure (BP) control, we performed a 4-arm randomized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center.

Methods Eligible patients were randomized to either usual care or 1 of 3 telephone-based intervention groups: (1) nurse-administered behavioral management, (2) nurse- and physician-administered medication management, or (3) a combination of both. Of the 1551 eligible patients, 593 individuals were randomized; 48% were African American. The intervention telephone calls were triggered based on home BP values transmitted via telemonitoring devices. Behavioral management involved promotion of health behaviors. Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines.

Results The primary outcome was change in BP control measured at 6-month intervals over 18 months. Both the behavioral management and medication management alone showed significant improvements at 12 months—12.8% (95% confidence interval [CI], 1.6%-24.1%) and 12.5% (95% CI, 1.3%-23.6%), respectively—but not at 18 months. In subgroup analyses, among those with poor baseline BP control, systolic BP decreased in the combined intervention group by 14.8 mm Hg (95% CI, −21.8 to −7.8 mm Hg) at 12 months and 8.0 mm Hg (95% CI, −15.5 to −0.5 mm Hg) at 18 months, relative to usual care.

Conclusions Overall intervention effects were moderate, but among individuals with poor BP control at baseline, the effects were larger. This study indicates the importance of identifying individuals most likely to benefit from potentially resource intensive programs.

Trial Registration clinicaltrials.gov Identifier: NCT00237692