1004. A Behavioral Stage Matched Intervention for Improving Hypertension Control
Sundar Natarajan, MD, MSc., VA New York Harbor Healthcare System, E Santa Ana, Ralph H. Johnson VAMC, PJ Nietert,
Center for Health Care Research, Charleston SC, KM Magruder,
Ralph H. Johnson VAMC
Objectives: To evaluate the efficacy of a Transtheoretical stage of change-matched telephone-delivered intervention for lowering blood pressure (BP) among veterans with hypertension.
Methods: Baseline stages of change for exercise, diet, and medications, and BP were assessed in 120 veterans with hypertension. Participants were randomized 1:1:1 to a stage-matched intervention (SMI) that targeted diet, exercise or medication adherence; a health education intervention (HEI); or usual care (UC). Interventions were conducted via monthly telephone calls to the SMI and HEI groups. Analysis of Covariance and logistic regression assessed effect on stage of change and BP at 6-month follow-up.
Results: There were no significant baseline differences between groups. At study completion, more participants in SMI were in action and maintenance for exercise (p<.001), diet (p<.001), and medications (p<.05) than participants in HEI or UC. Independent predictors (p<.05) for exercise maintenance were: SMI assignment and baseline exercise stage of change; and for diet maintenance: SMI and age. At 6-month follow-up, systolic BP (mm Hg, standard deviation) was significantly lower in SMI (129, 13.9) than HEI (139.2, 18.2, p=0.03) or UC (140.2, 19.5, p=0.02). Diastolic BP (mm Hg, standard deviation) was significantly lower in SMI (74.7, 8.9) than UC (81.3, 14, p=0.02), but not HEI (79, 9.1, p=0.09).
Conclusions: In this randomized study, a Transtheoretical stage of change-matched intervention led to improved adherence for exercise, diet, and taking medications, and lower BP among veterans with hypertension.
Impact: This study provides preliminary evidence that stage-matched interventions hold promise for improving hypertension control among veterans.