MIAMI BEACH (EGMN) – A combination of home blood pressure monitoring plus a tailored behavioral intervention delivered by a nurse significantly improved control of hypertension, compared with usual care, in a study of 636 patients.

In contrast, either intervention alone did not significantly improve control at 24 months.

“We saw about a 13% improvement in blood pressure [BP] control in the combined arm,” Hayden B. Bosworth, Ph.D., said, “so there is a synergistic effect of adding home BP monitoring and a telephone call from a nurse.”

Only an estimated 37% of the 65 million Americans with hypertension have control of their blood pressure (J. Clin. Hypertens. [Greenwich] 2008;10:311-6). This makes finding an effective intervention imperative, Dr. Bosworth said at the annual meeting of the Society of General Internal Medicine.

For the TCYB (Take Control of Your Blood Pressure) study, Dr. Bosworth and his associates enrolled and randomized patients at two university-affiliated primary care clinics. Patients were assigned to home BP monitoring alone, the behavioral intervention alone, the combined intervention, or usual care. At baseline and every 6 months, they assessed the percentage of participants who had a systolic BP lower than 140 mm Hg and a diastolic BP lower than 90 mm Hg. For participants with diabetes, target values were lower: 130 mm Hg or less systolic, and less than 80 mm Hg or less diastolic BP.

At baseline, 70% of patients had controlled blood pressure, “so we took everyone, controlled or not,” said Dr. Bosworth, a researcher at the Center for Health Services Research in Primary Care at the Durham (North Carolina) Veterans Affairs Medical Center. The patients’ mean age was 61 years, 49% were African American, and all were taking prescription medicine for hypertension at baseline.

There were no significant differences in the use of inpatient or outpatient health care resources among groups during the study.

“We asked patients to measure their BP every other day, keep it consistent, and mail back their diaries,” Dr. Bosworth said. Nurses called patients who received the behavioral intervention 12 times (once every other month). The nurses explained specific health behaviors that patients could adopt to improve BP control. Usual care consisted of BP management by a primary care provider.

At 24 months, 486 patients (76%) remained in the study. The proportion of patients with BP control increased from 70% at baseline to 83% at study’s end in the combined intervention group. At the same time, BP control increased from 77% to 83% in the home monitoring–only group, increased from 72% to 74% in the behavioral intervention–only group, and decreased from 72% to 67% in the usual care group.

The home BP monitoring–only and behavioral intervention–only groups showed improvement at 12 months, compared with usual care, but returned to BP levels similar to usual care at 24 months. In contrast, improvements in the combination group were sustained throughout the study. Dr. Bosworth said the 24-month follow-up is a strength of this trial, compared with the 12-month timeline in most other studies.

The cost of the home BP monitoring device was about $30, said Dr. Bosworth, also of Duke University, Durham. The total additional cost associated with these interventions was $90 in the home BP monitor–only group, $345 for the nurse calls only, and $415 for the combined intervention.

“The combination of home monitoring with patient self-management interventions may be a valuable tool for improving BP control rates,” Dr. Bosworth said.

Future plans may include studying differences in intervention by ethnicity. “One thing we are still wrestling with is all the effects we are seeing are among African Americans,” Dr. Bosworth said. “The whites are more like the usual care group.”

The study was sponsored by a Pfizer Health Communication Initiative Award and grants from the American Heart Association and the National Heart, Lung, and Blood Institute.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

迈阿密(EGMN)——一项纳入636例患者的研究显示，一种联合干预模式——家庭血压监测联合个体化行为干预（由一名护士通过电话进行）可显著改善高血压控制率。

相比之下，单独给予其中任一种干预都不能显著改善血压控制。

“我们观察到，联合干预组的血压控制率有13%的改善，”Hayden B. Bosworth博士说：“因此家庭血压检测和护士打电话干预具有协同效应。”

6,500万美国高血压患者中，仅37%血压控制良好(J. Clin. Hypertens. [Greenwich] 2008;10:311-6)。找到一种有效的干预措施显得尤为重要。这是Bosworth博士在美国普通内科学会年会上报告的。

在这项名为TCYB（控制你的血压）的研究中，Bosworth博士等从两家大学附属的初级医疗诊所入组患者，并对其进行随机化分组。患者被随机分成4组：仅接受家庭血压监测，仅接受行为干预，联合干预，以及常规护理。在开始时和入组后每隔6个月，研究者评估收缩压低于140 mm Hg和舒张压低于90 mm Hg的受试者所占百分比。对于糖尿病患者，目标血压设定值更低：收缩压≤130 mm Hg，舒张压≤80 mm Hg。

开始时，70%的患者血压控制良好，“我们对每一例患者都进行了随访，无论其血压控制情况如何，”Bosworth博士说。Bosworth博士是北卡罗来纳州达拉莫退伍军人医学中心初级医疗健康服务研究中心的一名研究人员。研究开始时，患者的平均年龄为61岁，49%为非洲裔美国人，所有人均服用处方药治疗高血压。

研究期间，在门诊或住院的健康护理资源使用方面，各组患者之间没有显著性差异。

“我们让患者每两天测量一次血压，并坚持下去，然后让他们把记录邮寄过来，”Bosworth博士说。护士每两个月给接受行为干预的患者打一次电话。护士告诉患者用以改善血压控制的特殊健康行为，并对其进行解释。常规护理包括初级医疗提供者的血压管理。

到24个月时，有486例患者（76%）仍处于研究之中。联合干预组的血压控制率从开始时的70%增至研究结束时的83%。与此同时，仅接受家庭血压监测组的血压控制率从77%增至83%，仅接受行为干预组从72%增至74%，常规护理组则从72%降至67%。

与常规护理组相比，仅接受家庭血压监测组和仅接受行为干预组的血压在12个月时得到了改善，但到24个月时又回到与常规护理组相似的水平。相反，联合干预组的血压改善则贯穿整个研究。Bosworth博士说，历时24个月的随访是该研究的亮点所在，因为其他大多数研究都只随访了12个月。

家庭血压监测设备的成本约30美元，Bosworth博士说。Bosworth博士同时还任职于杜克大学。与上述干预措施相关的其他额外费用为：仅接受家庭血压监测组为90美元，仅接受护士电话行为干预组为345美元，联合干预组为415美元。

“家庭血压监测联合患者自我管理式干预可能是一种改善血压控制率的有价值方法，”Bosworth博士说。

进一步的计划可能包括研究种族对干预效果的影响。“我们仍然在努力寻找一个问题的答案，那就是我们所观察到的所有效果都出现在非洲裔美国人中，”Bosworth博士说，“接受干预的白人，其效果更接近于接受常规护理者。”

该研究是由辉瑞健康传播行动奖，以及美国心脏学会（AHA）和美国国立心、肺与血液研究所（NHLBI）资助的。 

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