A multimodal blood pressure control intervention in 3 healthcare systems

Am J Manag Care. 2011 Apr;17(4):e96-103.

Abstract

Objective: To determine if a multimodal intervention composed of patient education, home blood pressure (BP) monitoring, BP measurement reporting to an interactive voice response (IVR) phone system, and clinical pharmacist follow-up improves BP control compared with usual care.

Study design: Prospective study with patient enrollment, medication consultation and adjustment, remote BP monitoring, and follow-up at 6 months.

Methods: This randomized controlled trial was conducted at 3 healthcare systems in Denver, Colorado, including a large health maintenance organization, a Veterans Affairs medical center, and a county hospital. At each site, patients with uncontrolled BP were randomized to the multimodal intervention vs usual care for 6 months, with the primary end point of BP reduction.

Results: Of 338 patients randomized, 283 (84%) completed the study, including 138 intervention patients and 145 usual care patients. Baseline BP was higher in the intervention group vs the usual care group (150.5/89.4 vs 143.8/85.3 mm Hg). At 6 months, BPs were similar in the intervention group vs the usual care group (137.4 vs 136.7 mm Hg, P = .85 for systolic; 82.9 vs 81.1 mm Hg, P = .14 for diastolic). However, BP reductions were greater in the intervention group vs the usual care group (−13.1 vs −7.1 mm Hg, P = .006 for systolic; −6.5 vs −4.2 mm Hg, P = .07 for diastolic). Adherence to medications was similar between the 2 groups, but intervention patients had a greater increase in medication regimen intensity.

Conclusions: A multimodal intervention of patient education, home BP monitoring, BP measurement reporting to an IVR system, and clinical pharmacist follow-up achieved greater reductions in BP compared with usual care.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects*
  • Blood Pressure Monitoring, Ambulatory / methods*
  • Colorado
  • Female
  • Follow-Up Studies
  • Hospitals, Military
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Male
  • Medication Adherence
  • Middle Aged
  • Patient Education as Topic
  • Pharmacists
  • Prospective Studies
  • Telemedicine
  • Telephone
  • United States
  • United States Department of Veterans Affairs
  • Veterans

Substances

  • Antihypertensive Agents