PURPOSE:Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alonein a low-income, predominantly minority population. METHODS: We randomized 237 patients with poorly controlled hypertension at a primary care clinic to receive eitherhome blood pressure monitoring, weekly health coaching, and home titration of blood pressure medications if blood pressures were elevated (n = 129) vs home blood pressure monitoring and health coaching but no home titration (n = 108). The primary outcome was change in systolic blood pressure from baseline to 6 months. RESULTS: Both the home-titration arm and the no-home-titration arm had a reduction in systolic blood pressure, with no significant difference between them. When both arms were combined and analyzed as a before-after study, there was a mean decrease in systolic blood pressure of 21.8 mm Hg (P <.001) as well as a decrease in the number of primary care visits from 3.5 in the 6 months before the study to 2.6 during the 6-month study period (P <.001) and 2.4 in the 6 months after the study (P <.001). The more coaching encounters patients had, the greater their reduction in blood pressure. CONCLUSIONS:Blood pressure control in a low-income, minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular, by counseling them on medication adherence. The improved blood pressure control can be achieved while reducing the time spent by physicians.
RCT Entities:
PURPOSE: Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income, predominantly minority population. METHODS: We randomized 237 patients with poorly controlled hypertension at a primary care clinic to receive either home blood pressure monitoring, weekly health coaching, and home titration of blood pressure medications if blood pressures were elevated (n = 129) vs home blood pressure monitoring and health coaching but no home titration (n = 108). The primary outcome was change in systolic blood pressure from baseline to 6 months. RESULTS: Both the home-titration arm and the no-home-titration arm had a reduction in systolic blood pressure, with no significant difference between them. When both arms were combined and analyzed as a before-after study, there was a mean decrease in systolic blood pressure of 21.8 mm Hg (P <.001) as well as a decrease in the number of primary care visits from 3.5 in the 6 months before the study to 2.6 during the 6-month study period (P <.001) and 2.4 in the 6 months after the study (P <.001). The more coaching encounters patients had, the greater their reduction in blood pressure. CONCLUSIONS: Blood pressure control in a low-income, minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular, by counseling them on medication adherence. The improved blood pressure control can be achieved while reducing the time spent by physicians.
Authors: David Margolius; Jennifer Wong; Matthew L Goldman; James Rouse-Iniguez; Thomas Bodenheimer Journal: J Am Board Fam Med Date: 2012 Mar-Apr Impact factor: 2.657
Authors: Eni C Okonofua; Kit N Simpson; Ammar Jesri; Shakaib U Rehman; Valerie L Durkalski; Brent M Egan Journal: Hypertension Date: 2006-01-23 Impact factor: 10.190
Authors: Peter Rudd; Nancy Houston Miller; Judy Kaufman; Helena C Kraemer; Albert Bandura; George Greenwald; Robert F Debusk Journal: Am J Hypertens Date: 2004-10 Impact factor: 2.689
Authors: Beverly B Green; Andrea J Cook; James D Ralston; Paul A Fishman; Sheryl L Catz; James Carlson; David Carrell; Lynda Tyll; Eric B Larson; Robert S Thompson Journal: JAMA Date: 2008-06-25 Impact factor: 56.272
Authors: Dean Schillinger; John Piette; Kevin Grumbach; Frances Wang; Clifford Wilson; Carolyn Daher; Krishelle Leong-Grotz; Cesar Castro; Andrew B Bindman Journal: Arch Intern Med Date: 2003-01-13
Authors: Heather Bennett; Kelsey Laird; David Margolius; Victoria Ngo; David H Thom; Thomas Bodenheimer Journal: BMC Public Health Date: 2009-12-10 Impact factor: 3.295
Authors: Amanda D Hyre; Marie A Krousel-Wood; Paul Muntner; Lumie Kawasaki; Karen B DeSalvo Journal: J Clin Hypertens (Greenwich) Date: 2007-03 Impact factor: 3.738
Authors: Natalia I Heredia; MinJae Lee; Kevin O Hwang; Belinda M Reininger; Maria E Fernandez; Lorna H McNeill Journal: Contemp Clin Trials Date: 2019-06-21 Impact factor: 2.226
Authors: E P Bray; M I Jones; M Banting; S Greenfield; F D R Hobbs; P Little; B Williams; R J Mcmanus Journal: J Hum Hypertens Date: 2015-01-08 Impact factor: 3.012
Authors: Heather M Johnson; Lisa Sullivan-Vedder; KyungMann Kim; Patrick E McBride; Maureen A Smith; Jamie N LaMantia; Jennifer T Fink; Megan R Knutson Sinaise; Laura M Zeller; Diane R Lauver Journal: Contemp Clin Trials Date: 2019-01-21 Impact factor: 2.226
Authors: Wichai Aekplakorn; Paibul Suriyawongpaisal; Rassamee Tansirisithikul; Thida Sakulpipat; Phikul Charoensuk Journal: J Prim Care Community Health Date: 2015-11-16
Authors: Rachel Willard-Grace; Ellen H Chen; Danielle Hessler; Denise DeVore; Camille Prado; Thomas Bodenheimer; David H Thom Journal: Ann Fam Med Date: 2015-03 Impact factor: 5.166