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).
RCT (n=237)
Open-label
Randomly ordered and enclosed in sealed, consecutively numbered envelopes
No
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?
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.
Absolute Event Rate: -23.9% vs -19.3%
p-value: p=NS
PURPOSE: Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income, predominantly minority population. METHODS: We randomized 237 patients with poorly controlled hypertension at a primary care clinic to receive either home blood pressure monitoring, weekly health coaching, and home titration of blood pressure medications if blood pressures were elevated (n = 129) vs home blood pressure monitoring and health coaching but no home titration (n = 108). The primary outcome was change in systolic blood pressure from baseline to 6 months. RESULTS: Both the home-titration arm and the no-home-titration arm had a reduction in systolic blood pressure, with no significant difference between them. When both arms were combined and analyzed as a before-after study, there was a mean decrease in systolic blood pressure of 21.8 mm Hg (P <.001) as well as a decrease in the number of primary care visits from 3.5 in the 6 months before the study to 2.6 during the 6-month study period (P <.001) and 2.4 in the 6 months after the study (P <.001). The more coaching encounters patients had, the greater their reduction in blood pressure. CONCLUSIONS: Blood pressure control in a low-income, minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular, by counseling them on medication adherence. The improved blood pressure control can be achieved while reducing the time spent by physicians.
Margolius et al. (Tue,) conducted a 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).