What does this research mean for the field?

Adding home titration of antihypertensive medications to health coaching and home blood pressure monitoring does not significantly improve systolic blood pressure reduction compared to coaching and monitoring alone in a low-income, minority population. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 1, 2012The Annals of Family MedicineOpen Access

Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Poorly controlled hypertension (n=237). Intervention: Home blood pressure monitoring, weekly health coaching, and home titration of medications vs. Home blood pressure monitoring and health coaching but no home titration. Primary outcome: Change in systolic blood pressure from baseline to 6 months (p=NS).

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Key result

Adding home titration to health coaching and home monitoring did not significantly reduce systolic blood pressure compared to coaching and monitoring alone (difference of -4.6 mm Hg, NS).

Why the study?

Does health coaching with home titration of antihypertensive medications improve blood pressure control compared with health coaching alone in a low-income, minority population with poorly controlled hypertension?

Population

237 adults with poorly controlled hypertension at a primary care clinic serving a low-income population…

Comparison

Home blood pressure monitoring, weekly health… vs Home blood pressure monitoring and weekly health…

Design

RCT, Study arm assignments were randomly ordered and enclosed in sealed…

Follow-up

6 months

Authors

DMDavid MargoliusMetroHealth TBT. BodenheimerUniversity of California, San Francisco HBHunter BennettNorthwestern University

Discussion

Member takes

Implication

Adding home titration confers no added BP benefit over coaching plus monitoring; challenges routine inclusion of self-titration in hypertension self-management programs.

Study Design

Type

RCT (n=237)

Blinding

Open-label

Randomization

Randomly ordered and enclosed in sealed, consecutively numbered envelopes

Multicenter

Structured PICO

Population

237 adults (mean age 60.4, 63.2% women, >90% racial/ethnic minorities) with poorly controlled hypertension (SBP ≥145 or DBP ≥90 mm Hg) at a primary care clinic serving a low-income population. Excluded: age <30 years, non-English/Spanish/Cantonese/Vietnamese speaking, creatinine >1.5 mg/dL, NYHA class III or IV heart failure, life expectancy <1 year.

Intervention

Home blood pressure monitoring, weekly health coaching by nonprofessionals, and home titration of antihypertensive medications using an algorithm if blood pressures were elevated (>140/90 mm Hg) for 6 months.

Comparator

Home blood pressure monitoring and weekly health coaching by nonprofessionals, but no home titration of medications.

Outcome

Change in systolic blood pressure from baseline to 6 months.surrogate

Main Result

Absolute Event Rate: -23.9% vs -19.3%

p-value: p=NS

Health coaching combined with home blood pressure monitoring significantly reduced systolic blood pressure in a low-income, minority population, though adding home titration of medications did not provide additional significant benefit over coaching alone.

Limitations

Lack of a usual-care control arm to substantiate the improvement found in both intervention arms
Use of blood pressures measured by medical assistants at office visits may have introduced random error
Association between number of coaching encounters and SBP reduction relied on observational data and could reflect confounding
Self-reported adherence correlates poorly with objective measures and decreased over the study
Only 20 patients in the home-titration arm actually undertook an adjustment of their medication at home
Lack of a usual-care arm
Association between number of coaching encounters and SBP reduction relied on observational data
Self-reported adherence decreased over the course of the study

Cite This Study

Margolius et al. (2012) conducted an RCT in Poorly controlled hypertension (n=237). Home blood pressure monitoring, weekly health coaching, and home titration of medications vs. Home blood pressure monitoring and health coaching but no home titration was evaluated on Change in systolic blood pressure from baseline to 6 months (p=NS). Adding home titration to health coaching and home monitoring did not significantly reduce systolic blood pressure compared to coaching and monitoring alone (difference of -4.6 mm Hg, NS).

synapsesocial.com/papers/6a17187287c007abbc05580c https://doi.org/10.1370/afm.1369

Topics

Hypertension management

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Implication

Adding home titration confers no added BP benefit over coaching plus monitoring; challenges routine inclusion of self-titration in hypertension self-management programs.

Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider