title: CoCo trial: Color-coded blood pressure Control, a randomized controlled study.
abstract: BACKGROUND
  Inadequate blood pressure (BP) control is a frequent challenge in general practice. The objective of this study was to determine whether a color-coded BP booklet using a traffic light scheme (red, >180 mmHg systolic BP and/or >110 mmHg diastolic BP; yellow, >140-180 mmHg systolic BP or >90-110 mmHg diastolic BP; green, ≤140 mmHg systolic BP and ≤90 mmHg diastolic BP) improves BP control and adherence with home BP measurement.
  
  
  METHODS
  In this two-group, randomized controlled trial, general practitioners recruited adult patients with a BP >140 mmHg systolic and/or >90 mmHg diastolic. Patients in the control group received a standard BP booklet and the intervention group used a color-coded booklet for daily home BP measurement. The main outcomes were changes in BP, BP control (treatment goal <140/90 mmHg), and adherence with home BP measurement after 6 months.
  
  
  RESULTS
  One hundred and twenty-one of 137 included patients qualified for analysis. After 6 months, a significant decrease in systolic and diastolic BP was achieved in both groups, with no significant difference between the groups (16.1/7.9 mmHg in the intervention group versus 13.1/8.6 mmHg in the control group, P=0.3/0.7). BP control (treatment target <140/90 mmHg) was achieved significantly more often in the intervention group (43% versus 25%; P=0.037; number needed to treat of 5). Adherence with home BP measurement overall was high, with a trend in favor of the intervention group (98.6% versus 96.2%; P=0.1).
  
  
  CONCLUSIONS
  Color-coded BP self-monitoring significantly improved BP control (number needed to treat of 5, meaning that every fifth patient utilizing color-coded self-monitoring achieved better BP control after 6 months), but no significant between-group difference was observed in BP change. A markedly higher percentage of patients achieved BP values in the normal range. This simple, inexpensive approach of color-coded BP self-monitoring is user-friendly and applicable in primary care, and should be implemented in the care of patients with arterial hypertension.
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
authors.forename: Valerio
authors.initials: V
authors.lastname: Del Prete
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Steurer-Stey
keywords: general practitioner; high blood pressure; home blood pressure measurement; hypertension; number needed to treat; primary care