Two self-management interventions to improve hypertension control: a randomized trial.
Two self-management interventions to improve hypertension control: a randomized trial.
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DOI：
10.7326/0003-4819-151-10-200911170-00148
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发表时间：
2009-11-17
影响因子：
39.2
通讯作者：
Oddone EZ
中科院分区：
文献类型：
--
作者：
Bosworth HB;Olsen MK;Grubber JM;Neary AM;Orr MM;Powers BJ;Adams MB;Svetkey LP;Reed SD;Li Y;Dolor RJ;Oddone EZ
不到40%的美国高血压患者有足够的血压控制。比较两种自我管理干预措施对提高高血压患者血压控制的效果。一项按入组地点和患者识字状况分层的2 × 2随机试验，随访2年（2004年5月-2008年1月）。两所大学附属初级保健诊所。在2060例合格的高血压患者中，636例患者被随机分配（招募率为31%）。研究助理通过集中设盲和分层随机化算法对合格患者进行随机化，以接受：1）常规护理; 2）针对高血压相关行为的每两个月定制护士管理的电话干预; 3）BP监测，包括每周测量BP三次，或4）两种干预的组合。主要结局是在24个月内每隔6个月评价一次血压控制。475例（75%）完成了24个月BP随访。在24个月时，干预组相对于常规护理组的血压控制比例改善为：行为组，4.3%（95% CI：-4.5%，12.9）;家庭血压监测组，7.6%（95% CI：-1.9%，17.0%）;联合干预组，11.0%（95% CI：1.9%，19.8%）。对于收缩压，相对于常规治疗，行为干预组的24个月差异为+0.6 mmHg（95% CI：-2.2，3.4），家庭监测组为-0.6 mmHg（95% CI：-3.6，2.3），联合干预组为-3.9 mmHg（95% CI：-6.9，-0.9）。在24个月时观察到舒张压的相似模式。仅在干预参与者中监测药物使用和饮食的变化; 25%缺乏24个月的结果数据; 73%在基线时血压控制充分;研究环境是学术健康中心，所有因素都可能限制普遍性。与常规护理相比，家庭血压监测和定制的行为电话干预相结合可改善24个月时的血压控制、收缩压和舒张压。
Less than 40% of Americans with hypertension have adequate blood pressure (BP) control. To compare two self-management interventions for improving BP control among hypertensive patients. A 2 by 2 randomized trial stratified by enrollment site and patient literacy status with two-year follow-up (5/2004-1/2008). Two university-affiliated primary care clinics. 636 patients were randomized (31% recruitment rate) among the 2060 eligible hypertensive patients. Research assistants randomized eligible patients via a centralized blinded and stratified randomization algorithm to receive either: 1) usual care; 2) bi-monthly tailored nurse-administered telephone intervention targeting hypertension-related behaviors; 3) BP monitoring consisting of measuring BP three times per week, or; 4) a combination of the two interventions. The primary outcome was BP control evaluated at six-month intervals over 24 months. 475 (75%) completed the 24-month BP follow-up. Improvements in proportion of BP control for the intervention groups relative to the usual care group at 24 months were: behavioral group, 4.3% (95% CI: −4.5%, 12.9); home BP monitoring group, 7.6% (95% CI: −1.9%, 17.0%); and, combined interventions, 11.0% (95% CI: 1.9%, 19.8%). For systolic BP, relative to usual care, the 24 month difference was, +0.6 mmHg (95% CI: −2.2, 3.4) for the behavioral intervention group, −0.6 mmHg (95% CI: −3.6, 2.3) for the home monitoring group, and −3.9 mmHg (95% CI: −6.9, −0.9) for the combined interventions. Similar patterns were observed for diastolic BP at 24 months. Changes in medication use and diet were only monitored in intervention participants; 25% lacked 24 month outcome data; 73% had adequate BP control at baseline; the study setting was an academic health center, all factors that potentially limit generalizability. Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care.
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影响因子：
8.3
作者：
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通讯作者：
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