The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial.
BACKGROUND
Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control.


METHODS
The randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n=150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction.


CONCLUSIONS
The present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention.


BACKGROUND
ClinicalTrials.gov identifier: NCT01013857.
Bennett
Heather
H
Department of Family and Community Medicine, University of California, San Francisco (UCSF), 1001 Potrero Ave, Building 80/83, San Francisco, CA 94110, USA. heather.bennett@ucsf.edu
Laird
Kelsey
K
Margolius
David
D
Ngo
Victoria
V
Thom
David H
DH
Bodenheimer
Thomas
T
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory; D002985:Clinical Protocols; D005260:Female; D006699:Home Care Services; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D011203:Poverty; D012648:Self Care / Q000379:methods; D017216:Telemedicine
D000959:Antihypertensive Agents