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2015 HSR&D/QUERI National Conference Abstract

1086 — Sustainability of a Behavioral Intervention to Lower Systolic Blood Pressure and Improve Hypertension Control: Outcomes of a Randomized Trial

Rodriguez MA, VA NY Harbor Healthcare System; Friedberg J, VA NY Harbor Healthcare System; Wang B, New York University; Fang Y, New York University; Natarajan S|, VA NY Harbor Healthcare System;

Many Veterans with hypertension continue to have elevated blood pressure (BP) despite known effective treatment. We recently published findings on the effect of a tailored behavioral intervention to improve BP at 6 months. Here, we report on the sustainability of the intervention at 12 months, i.e. 6 months after stopping the intervention.

We conducted a Randomized Controlled Trial to evaluate the effectiveness of a Transtheoretical Model-based stage-matched intervention (SMI) and a non-tailored health education intervention (HEI) to improve BP through monthly telephone calls focusing on diet, exercise and medication adherence, by comparing to usual care (UC). BP was measured at baseline, 6 months (immediately post-intervention) and 12 months (6 months post-intervention). Generalized estimating equations were used to evaluate the effect; utilizing all available data, taking into account correlations between repeated BP measurements and adjusting for baseline BP.

Participants with repeated uncontrolled BP (n = 533) were randomized into the 3 groups. There were no differences between groups at baseline. At 12-month follow-up, the proportion of SMI, HEI and UC with BP controlled were 61.84%, 60.13%, and 52.23%. Compared to UC, SMI participants were 1.8 times more likely to have BP controlled between 6 and 12 months (OR 1.8. 95% CI: 1.27-2.66), and HEI participants were 1.5 times more likely to have BP under control (95% CI: 1.01-2.12). The adjusted analyses for systolic BP indicate that the mean effect of SMI was 2.80 mmHg lower (95% CI: -5.33, -0.26) than UC (p = 0.03), while the mean effect of HEI was 2.56 mmHg lower (95% CI: -5.54, +0.42,) than UC (p = 0.09).

Both the telephone-delivered tailored SMI and the non-tailored HEI resulted in sustained improvement in BP control at 12 months; SMI had a greater effect. SMI also led to a significant sustained lowering in SBP at 12 months while HEI was not significant.

Depending on need and the resources available, decision makers can choose either SMI or HEI to improve longer-term BP control rates. These could be important new tools to improve BP control, particularly in VHA where telephone care through Telehealth and Patient-Aligned Care Teams are implemented.