Two self-management interventions to improve hypertension control: a randomized trial

Ann Intern Med. 2009 Nov 17;151(10):687-95. doi: 10.7326/0003-4819-151-10-200911170-00148.


Background: Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control.

Objective: To compare 2 self-management interventions for improving BP control among hypertensive patients.

Design: A 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. ( registration number: NCT00123058).

Setting: 2 university-affiliated primary care clinics.

Patients: 636 hypertensive patients.

Intervention: A 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.

Measurements: The primary outcome was BP control at 6-month intervals over 24 months.

Results: 475 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.

Limitation: Changes 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.

Conclusion: Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care. .

Publication types

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

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Behavior Therapy / economics
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory / economics
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / diet therapy
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Male
  • Middle Aged
  • Nursing Care / methods
  • Patient Compliance
  • Random Allocation
  • Telephone


  • Antihypertensive Agents

Associated data