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Self-Management for Hypertension

Two interventions helped patients reach blood pressure goals.

Because many hypertensive patients do not achieve good control of blood pressure (BP), strategies are needed beyond physician adjustment of medication based on office-visit BP measurements. In a study of two self-management strategies, North Carolina investigators randomized 636 patients with hypertension to receive bimonthly nurse-delivered telephone calls, with tailored behavioral counseling focused on medication adherence; thrice-weekly home BP measurement, with values recorded in logs (logs were mailed to primary care providers every 2 months); both interventions; or usual care. BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg for patients without diabetes, and systolic BP <130 mm Hg and diastolic BP <80 mm Hg for patients with diabetes.

At 24 months, BP control was achieved by 11% more patients in the combined-intervention group than in the usual-care group. The drop in systolic BP from baseline was also significant only for the combined-intervention group (3.9 mm Hg lower than usual care alone).

Comment: To achieve better outcomes for patients with chronic conditions, we need to go beyond what we can do in the confines of office visits. Implementation of these two strategies for management of hypertension seems feasible, as long as resources are available. Similar strategies likely would work for other chronic conditions.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine December 3, 2009

Citation(s):

Bosworth HB et al. Two self-management interventions to improve hypertension control: A randomized trial. Ann Intern Med 2009 Nov 17; 151:687.

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