Telephone-based behavioral and medication management improved BP control at 12 months (12.8% and 12.5% improvements, respectively), but these effects were not sustained at 18 months.
RCT (n=593)
4-arm randomized
No
Do telephone-based behavioral and/or medication management interventions triggered by home blood pressure telemonitoring improve blood pressure control in primary care patients?
Telephone-based home blood pressure management interventions provide moderate improvements in blood pressure control, with the greatest benefit seen in patients with poor baseline control.
Effect estimate: 12.8% improvement (behavioral) (95% CI 1.6%-24.1%)
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.
Hayden B. Bosworth (Mon,) conducted a rct in Hypertension (n=593). Telephone-based behavioral management, medication management, or both vs. Usual care was evaluated on Change in BP control measured at 6-month intervals over 18 months (12.8% improvement (behavioral), 95% CI 1.6%-24.1%). Telephone-based behavioral and medication management improved BP control at 12 months (12.8% and 12.5% improvements, respectively), but these effects were not sustained at 18 months.
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