Study Suggests Behavioral and Medication Management Interventions Improve Blood Pressure Control for Veterans

BACKGROUND:
Improving the rate of blood pressure (BP) control may require expanding the model of care delivery beyond traditional clinic-based physician visits. For example, interventions that use home BP tele-monitoring may enhance access and improve outcomes for adults with hypertension. This randomized clinical trial evaluated three nurse-led, home tele-monitoring interventions that were developed to improve BP – and also tested which intervention was most effective among 593 Veterans treated in VA primary care over 18 months. The interventions included Behavioral Management – promotion of healthy behaviors aimed at improving hypertension self-management; Medication Management – adjustment of medications based on hypertension guidelines; and a combination of the two interventions. The primary outcome was BP at baseline and 6, 12, and 18 months. Investigators assessed differences between each intervention and usual care, as well as costs.

FINDINGS:

• Overall, the behavioral and medication management intervention groups had a greater increase in the proportion of Veterans with BP measurements within target (12.8% and 12.5%, respectively) relative to the usual care group at 12 months. These findings were not sustained at 18 months; however, among Veterans with poor baseline BP control, the combined intervention significantly decreased blood pressure at both 12 and 18 months.
• In sub-group analyses, among those with poor baseline BP control, systolic BP decreased among Veterans in the combined group by 14.8 mm Hg at 12 months and 8.0 mm Hg at 18 months compared to Veterans in the usual care group.
• Intervention costs over 18 months were $947 for behavioral management, $1,275 for medication management, and $1,153 for the combined intervention.

LIMITATIONS:

• The home BP values and those obtained by research staff were lower, on average, than the values obtained in the primary care clinics. The fact that study BPs were lower than anticipated may have hampered investigators’ ability to detect larger improvements in BP control in the overall analyses.
• Caution should be exercised in interpreting post-hoc sub-group analyses given that they were not initially planned.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 04-426). Dr. Bosworth also was supported by an HSR&D Research Career Scientist Award. Drs. Bosworth, Powers, and Olsen are part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.

Bosworth H, Powers B, Olsen M, et al. Can Home Blood Pressure Management Improve Blood Pressure Control: Results from a Randomized Controlled Trial. Archives of Internal Medicine July 11, 2011;171(13):1173-80.