title: Health coaching to improve hypertension treatment in a low-income, minority population.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family and Community Medicine, University of California-San Francisco, CA 94110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Margolius
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer
authors.forename: Heather
authors.initials: H
authors.lastname: Bennett
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wong
authors.forename: Victoria
authors.initials: V
authors.lastname: Ngo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Padilla
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
mesh_terms: D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003150:Community Health Workers; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008913:Minority Groups; D011203:Poverty; D011320:Primary Health Care / Q000379:methods*; D012648:Self Care / Q000379:methods*; D014481:United States