Sustained Benefit of Alternate Behavioral Interventions to Improve Hypertension Control: A Randomized Clinical Trial

Abstract

Little is known about the long-term effects of behavioral interventions to improve blood pressure (BP) control. We evaluated whether a telephone-delivered, behavioral stage-matched intervention (SMI), or a nontailored health education intervention (HEI) delivered for 6 months improves BP control (or lowers systolic BP) over 12 months, as well as its sustainability 6 months after intervention implementation ended, compared with usual care in participants with repeated uncontrolled BP at baseline. A 3-arm, randomized controlled trial was designed to evaluate the effectiveness of 2 interventions, each compared with a usual-care control group. Participants were 533 adults with persistent uncontrolled BP who were treated at 2 Veterans Affairs Medical Centers. The intervention was implemented for 6 months, followed by 6 months of observation. Compared with usual care, the odds of having BP under control over 12 months in SMI were 84% higher (odds ratio, 1.84 [95% CI, 1.28-2.67]; P=0.001), and 48% higher in HEI (odds ratio, 1.48 [95% CI, 1.02-2.14]; P=0.04).Over the 12 months, compared with usual care, systolic blood pressure was 2.80 mm Hg lower in SMI ([95% CI, 0.27 to 5.33]; P=0.03) while it was 2.58 mm Hg lower in HEI ([95% CI, -0.40 to 5.55]; P=0.09). From 6 to 12 months, SMI sustained improved BP control and lower systolic blood pressure, while HEI, which did not have significantly better BP control or lower systolic blood pressure at 6 months, appeared to improve BP control and lower systolic blood pressure. SMI and HEI are promising interventions that can be implemented in clinical practice to improve BP management. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00286754.