title: Home blood pressure management and improved blood pressure control: results from a randomized controlled trial.
abstract: 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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00237692.
authors: Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. hayden.bosworth@duke.edu
authors: Hayden B
authors: HB
authors: Bosworth
authors: Benjamin J
authors: BJ
authors: Powers
authors: Maren K
authors: MK
authors: Olsen
authors: Felicia
authors: F
authors: McCant
authors: Janet
authors: J
authors: Grubber
authors: Valerie
authors: V
authors: Smith
authors: Pamela W
authors: PW
authors: Gentry
authors: Cynthia
authors: C
authors: Rose
authors: Courtney
authors: C
authors: Van Houtven
authors: Virginia
authors: V
authors: Wang
authors: Mary K
authors: MK
authors: Goldstein
authors: Eugene Z
authors: EZ
authors: Oddone
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D003131:Combined Modality Therapy / Q000191:economics / Q000379:methods; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D010820:Physicians; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012107:Research Design; D017216:Telemedicine / Q000191:economics; D055817:Telenursing / Q000191:economics; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents