Home Blood Pressure Management and Improved Blood Pressure Control Results From a Randomized Controlled Trial
Home Blood Pressure Management and Improved Blood Pressure Control Results From a Randomized Controlled Trial
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DOI：
10.1001/archinternmed.2011.276
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发表时间：
2011-07-11
影响因子：
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通讯作者：
Oddone, Eugene Z.
中科院分区：
文献类型：
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作者：
Bosworth, Hayden B.;Powers, Benjamin J.;Oddone, Eugene Z.
背景：为了确定三种干预措施中哪一种在改善血压控制方面最有效，我们在退伍军人事务医疗中心的初级保健诊所进行了一项4组随机试验，随访18个月。方法：符合条件的患者被随机分配到常规护理组或三个电话干预组中的一个：(1)护士管理的行为管理，(2)护士和医生管理的药物管理，或(3)两者结合。在1551例符合条件的患者中，593人被随机分组；48%是非裔美国人。干预电话是根据通过远程监控设备传输的家庭血压值触发的。行为管理包括促进健康行为。药物管理包括由研究医师和护士根据高血压治疗指南调整药物。结果：主要结果是在18个月内每隔6个月测量一次血压控制的变化。单独的行为管理和药物管理在12个月时分别表现出12.8%（95%可信区间[CI]， 1.6%-24.1%）和12.5% （95% CI, 1.3%-23.6%）的显著改善，但在18个月时则无显著改善。在亚组分析中，在基线血压控制较差的患者中，与常规治疗相比，联合干预组收缩压在12个月时降低了14.8 mm Hg (95% CI, -21.8至-7.8 min Hg)，在18个月时降低了8.0 mm Hg （95% CI, -15.5至-0.5 mm Hg）。结论：总体干预效果中等，但在基线时血压控制较差的个体中，干预效果更大。这项研究表明，识别最有可能从潜在的资源密集型项目中受益的个人是非常重要的。
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 min 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.