Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial.
Blood pressure (BP) control rates are suboptimal. We evaluated the effectiveness of 2 behavioral interventions to improve BP control via a 3-arm, randomized controlled trial of 533 adults with repeated uncontrolled BP, despite antihypertensive drug treatment for ≥6 months. The interventions were a tailored stage-matched intervention (SMI) or a nontailored health education intervention (HEI) of 6 monthly calls targeting diet, exercise, and medication. Control was usual care (UC). There were no baseline group differences. Baseline BP control was 42.6%, 40.6%, and 44.6% in SMI, HEI, and UC (P=0.74), respectively; systolic BP (with SEs) was 136 (0.89), 137 (1.33), and 137 (0.96) mm Hg. Six-month control was 64.6% (SMI), 54.3% (HEI), and 45.8% (UC) (P values for pairwise comparisons versus UC, 0.001 [SMI] and 0.108 [HEI]). At 6 months, systolic BP (SE) was 131.2 (1.05), 131.8 (0.99), and 134.7 (1.02) for SMI, HEI, and UC, respectively (P values for pairwise comparisons versus UC, 0.009 for SMI and 0.047 for HEI). SMI led to lower systolic BP and better BP control than UC. SMI constitutes a new, potent approach to assist patients with uncontrolled hypertension to reach BP goals.


BACKGROUND
http://www.clinicaltrials.gov. Unique identifier: NCT00286754.
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Jennifer P
JP
Friedberg
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Maria A
MA
Rodriguez
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Michelle E
ME
Watsula
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Iris
I
Lin
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Judith
J
Wylie-Rosett
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
John P
JP
Allegrante
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.).
Stuart R
SR
Lipsitz
From the Research and Development Service (J.P.F., M.A.R., M.E.W., I.L.) and Medical Service (S.N.), VA New York Harbor Healthcare System, NY; Departments of Medicine (J.P.F., S.N.) and Psychiatry (J.P.F.), New York University School of Medicine, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.W.-R.); Department of Health Education, Teachers College and the Mailman School of Public Health, Columbia University, New York, NY (J.P.A.); and Departments of Medicine and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.R.L.). Sundar.Natarajan@va.gov.
Sundar
S
Natarajan
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D048909:Diabetes Complications; D037001:Directive Counseling / Q000379:methods; D005081:Exercise Therapy / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D057285:Precision Medicine / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D020377:Self Efficacy; D016037:Single-Blind Method; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome
D000959:Antihypertensive Agents
diet; exercise; hypertension; randomized controlled trial