• Hayden B Bosworth, Maren K Olsen, Janet M Grubber, Alice M Neary, Melinda M Orr, Benjamin J Powers, Martha B Adams, Laura P Svetkey, Shelby D Reed, Yanhong Li, Rowena J Dolor, and Eugene Z Oddone.
• Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Center for Aging and Human Development, Duke Hypertension Center, and Duke Clinical Research Institute, Duke University, Durham, North Carolina 27703, USA. hayden.bosworth@duke.edu
• Ann. Intern. Med. 2009 Nov 17; 151 (10): 687695687-95.

BackgroundFewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control.ObjectiveTo compare 2 self-management interventions for improving BP control among hypertensive patients.DesignA 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058).Setting2 university-affiliated primary care clinics.Patients636 hypertensive patients.InterventionA centralized, blinded, and stratified randomization algorithm was used to randomly assign eligible patients to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring.MeasurementsThe primary outcome was BP control at 6-month intervals over 24 months.Results475 patients (75%) completed the 24-month BP follow-up. At 24 months, improvements in the proportion of patients with BP control relative to the usual care group were 4.3% (95% CI, -4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, -1.9% to 17.0%) in the home BP monitoring group, and 11.0% (CI, 1.9%, 19.8%) in the combined intervention group. Relative to usual care, the 24-month difference in systolic BP was 0.6 mm Hg (CI, -2.2 to 3.4 mm Hg) for the behavioral intervention group, -0.6 mm Hg (CI, -3.6 to 2.3 mm Hg) for the BP monitoring group, and -3.9 mm Hg (CI, -6.9 to -0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP.LimitationChanges in medication use and diet were monitored only in intervention participants; 24-month outcome data were missing for 25% of participants, BP control was adequate at baseline in 73% of participants, and the study setting was an academic health center.ConclusionCombined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care. .

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