2011 National Meeting

1058 — A Behavioral Intervention to Improve Hypertension Control: Primary Outcomes of a Randomized Controlled Trial

Natarajan S (VA New York Harbor Healthcare System) , Friedberg J (VA New York Harbor Healthcare System), Ulmer M (VA New York Harbor Healthcare System), Lin I (VA New York Harbor Healthcare System), Robinaugh D (VA New York Harbor Healthcare System), Allegrante JP (Teachers College, Columbia University), Wylie-Rosett J (Albert Einstein College of Medicine), Lipsitz SR (Brigham and Womens Hospital, Boston)

Objectives:
The effectiveness of blood pressure (BP) control (systolic BP [SBP] < 130 mm Hg and diastolic BP [DBP] < 80 mm Hg in diabetes or kidney disease; or SBP < 140 mm Hg and DBP < 90 mm Hg in all others) in preventing cardiovascular events is proven. A large gap exists between ideal control rates and what is achieved in practice.

Methods:
Using a 3-arm, randomized controlled trial, we evaluated the effect of a stage-matched intervention (SMI) or a health education intervention (HEI) to improve BP control in adults with uncontrolled BP despite treatment with antihypertensive drugs for > = 6 months; usual care (UC) served as control. The SMI and HEI groups received monthly phone counseling targeting diet, exercise and BP medication adherence for 6 months; SMI used the Transtheoretical Model to tailor counseling while HEI received nontailored education using national guidelines. Participants made study visits at baseline, 3, and 6 months. BP, the primary outcome, was assessed from the mean of 6 readings and categorized as controlled or not. Comparisons between groups were by Chi-squared tests.

Results:
We recruited and randomized 533 participants with sustained uncontrolled BP. The baseline BP control rates were 42.6%, 40.6%, and 44.6% in SMI, HEI, and UC (p = .74). The 6 month BP control rates were 62.3% (SMI), 52.4% (HEI), and 47.2% (UC) with p values for pairwise comparisons being .016 (SMI vs. UC), .280 (HEI vs. UC), and .066 (SMI vs. HEI). The change in BP control from baseline to 6 months by arm were 19.5% (SMI), 11.9% (HEI) and 0.6 % (UC) with p values for the null hypothesis of change = 0 within each arm being 0.00003 (SMI), 0.012 (HEI) and 0.887 (UC).

Implications:
SMI improved BP control compared to UC. Both SMI and HEI improved BP control compared to baseline. SMI constitutes a new, more potent approach to assisting patients reach BP control goals.

Impacts:
SMI may improve reach and be a cost-effective approach to enhance BP control in veterans. This could also be an effective approach in other chronic conditions.