Home blood pressure management and improved blood pressure control: results from a randomized controlled trial

Arch Intern Med. 2011 Jul 11;171(13):1173-80. doi: 10.1001/archinternmed.2011.276.


Background: To determine which of 3 interventions was most effective in improving blood pressure (BP) control, we performed a 4-arm randomized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center.

Methods: Eligible patients were randomized to either usual care or 1 of 3 telephone-based intervention groups: (1) nurse-administered behavioral management, (2) nurse- and physician-administered medication management, or (3) a combination of both. Of the 1551 eligible patients, 593 individuals were randomized; 48% were African American. The intervention telephone calls were triggered based on home BP values transmitted via telemonitoring devices. Behavioral management involved promotion of health behaviors. Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines.

Results: The primary outcome was change in BP control measured at 6-month intervals over 18 months. Both the behavioral management and medication management alone showed significant improvements at 12 months-12.8% (95% confidence interval [CI], 1.6%-24.1%) and 12.5% (95% CI, 1.3%-23.6%), respectively-but not at 18 months. In subgroup analyses, among those with poor baseline BP control, systolic BP decreased in the combined intervention group by 14.8 mm Hg (95% CI, -21.8 to -7.8 mm Hg) at 12 months and 8.0 mm Hg (95% CI, -15.5 to -0.5 mm Hg) at 18 months, relative to usual care.

Conclusions: Overall intervention effects were moderate, but among individuals with poor BP control at baseline, the effects were larger. This study indicates the importance of identifying individuals most likely to benefit from potentially resource intensive programs.

Trial registration: clinicaltrials.gov Identifier: NCT00237692.

Publication types

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

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Ambulatory Care Facilities
  • Antihypertensive Agents / administration & dosage*
  • Blood Pressure Monitoring, Ambulatory*
  • Blood Pressure* / drug effects
  • Combined Modality Therapy / economics
  • Combined Modality Therapy / methods
  • Drug Administration Schedule
  • Drug Prescriptions* / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Health Behavior*
  • Health Care Costs
  • Humans
  • Hypertension / drug therapy
  • Hypertension / economics
  • Hypertension / ethnology
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Male
  • Middle Aged
  • Nurse Clinicians
  • Physicians
  • Quality Indicators, Health Care
  • Quality of Health Care
  • Research Design
  • Telemedicine / economics
  • Telenursing / economics
  • Telephone
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology
  • United States Department of Veterans Affairs
  • Whites / statistics & numerical data


  • Antihypertensive Agents

Associated data

  • ClinicalTrials.gov/NCT00237692