title: Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?
abstract: BACKGROUND
  Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after completion of a hypertension self-management trial.
  
  
  RESULTS
  This study is a follow-up analysis of an 18-month, 4-arm, hypertension self-management trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 interventions. Clinic-derived systolic blood pressure obtained before, during, and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures, and total expenditures were estimated using generalized estimating equations. The 3 telephone-based interventions were nurse-administered health behavior promotion, provider-administered medication adjustments based on hypertension treatment guidelines, or a combination of both. Intervention calls were triggered by home BP values transmitted via telemonitoring devices. Clinical and economic outcomes were examined 12 months before, 18 months during, and 18 months after trial completion. Compared with usual care, patients randomized to the combined arm had greater improvement in proportion of BP control during and after the 18-month trial and estimated proportion of BP control improved 18 months after trial completion for patients in the behavioral and medication management arms. Among the patients with inadequate baseline BP control, estimated mean systolic BP was significantly lower in the combined arm as compared with usual care during and after the 18-month trial. Utilization and expenditure trends were similar for patients in all 4 arms.
  
  
  CONCLUSIONS
  Behavioral and medication management can generate systolic BP improvements that are sustained 18 months after trial completion.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00237692.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Edelman
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Kaufman
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012648:Self Care / Q000379:methods*; D017216:Telemedicine; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; group processes; health care costs; outcomes assessment (health care); veterans