title: A multimodal blood pressure control intervention in 3 healthcare systems.
abstract: OBJECTIVE
  To determine if a multimodal intervention composed of patient education, home blood pressure (BP) monitoring, BP measurement reporting to an interactive voice response (IVR) phone system, and clinical pharmacist follow-up improves BP control compared with usual care.
  
  
  METHODS
  Prospective study with patient enrollment, medication consultation and adjustment, remote BP monitoring, and follow-up at 6 months.
  
  
  METHODS
  This randomized controlled trial was conducted at 3 healthcare systems in Denver, Colorado, including a large health maintenance organization, a Veterans Affairs medical center, and a county hospital. At each site, patients with uncontrolled BP were randomized to the multimodal intervention vs usual care for 6 months, with the primary end point of BP reduction.
  
  
  RESULTS
  Of 338 patients randomized, 283 (84%) completed the study, including 138 intervention patients and 145 usual care patients. Baseline BP was higher in the intervention group vs the usual care group (150.5/89.4 vs 143.8/85.3 mm Hg). At 6 months, BPs were similar in the intervention group vs the usual care group (137.4 vs 136.7 mm Hg, P = .85 for systolic; 82.9 vs 81.1 mm Hg, P = .14 for diastolic). However, BP reductions were greater in the intervention group vs the usual care group (−13.1 vs −7.1 mm Hg, P = .006 for systolic; −6.5 vs −4.2 mm Hg, P = .07 for diastolic). Adherence to medications was similar between the 2 groups, but intervention patients had a greater increase in medication regimen intensity.
  
  
  CONCLUSIONS
  A multimodal intervention of patient education, home BP monitoring, BP measurement reporting to an IVR system, and clinical pharmacist follow-up achieved greater reductions in BP compared with usual care.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, USA. david.j.magid@kp.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.forename: Kari L
authors.initials: KL
authors.lastname: Olson
authors.forename: David W
authors.initials: DW
authors.lastname: Brand
authors.forename: Lesley K
authors.initials: LK
authors.lastname: Welch
authors.forename: Karen E
authors.initials: KE
authors.lastname: Snow
authors.forename: Anne C
authors.initials: AC
authors.lastname: Lambert-Kerzner
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003120:Colorado; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D010595:Pharmacists; D011446:Prospective Studies; D017216:Telemedicine; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents