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2015 HSR&D/QUERI National Conference Abstract

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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;

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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.