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Randomized Controlled Trial
. 2009 Dec 10:9:456.
doi: 10.1186/1471-2458-9-456.

The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial

Heather Bennett  1 , Kelsey Laird, David Margolius, Victoria Ngo, David H Thom, Thomas Bodenheimer
Affiliations
Randomized Controlled Trial

The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial

Heather Bennett et al. BMC Public Health. .

Abstract

Background: Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control.

Methods/design: The randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n=150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction.

Discussion: The present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention.

Trial registration: ClinicalTrials.gov identifier: NCT01013857.

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Figures

Figure 1
Figure 1
Home-titration algorithm for antihypertensive medications.
See this image and copyright information in PMC

References

    1. Walsh JM, McDonald KM, Shojania KG, Sundaram V, Nayak S, Lewis R, Owens DK, Goldstein MK. Quality improvement strategies for hypertension management: a systematic review. Med Care. 2006;44(7):646–657. doi: 10.1097/01.mlr.0000220260.30768.32. - DOI - PubMed
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2. - DOI - PubMed
    1. Cooper LA. A 41-year-old African American man with poorly controlled hypertension: review of patient and physician factors related to hypertension treatment adherence. Jama. 2009;301(12):1260–1272. doi: 10.1001/jama.2009.358. - DOI - PMC - PubMed
    1. Bosworth HB, Powers B, Grubber JM, Thorpe CT, Olsen MK, Orr M, Oddone EZ. Racial differences in blood pressure control: potential explanatory factors. J Gen Intern Med. 2008;23(5):692–698. doi: 10.1007/s11606-008-0547-7. - DOI - PMC - PubMed
    1. Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev. 2004. p. CD004804. - PMC - PubMed

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