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Hypertension self-management intervention yielded sustainable BP benefits
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Improvements to systolic BP control achieved during a hypertension self-management trial translated to sustained long-term benefits in a recent study.
In a follow-up analysis of an 18-month, four-arm trial, researchers evaluated the results of self-management strategies among 591 veterans with hypertension. All participants were receiving BP-lowering medication and had inadequate BP control (>140 mm Hg/90 mm Hg).
Patients were randomly assigned to standard hypertension care (n=147) or one of three telephone-based interventions: a physician-guided medication management approach using a clinical decision support system (n=149), a nurse-administered behavioral management intervention (n=148) or a combined behavioral/medication management system (n=147). Telemonitoring devices were used to transmit home BP measurements every other day, with intervention phone calls conducted when warranted by the results of a 2-week average BP measurement.
The researchers assessed clinical and financial outcomes 12 months before, during and 18 months after conclusion of the trial. BP control was the primary clinical outcome and was defined as BP of 140 mm Hg/90 mm Hg or lower for those without diabetes, and 130 mm Hg/80 mm Hg or lower for those with diabetes. Economic outcomes included the likelihood of one or more incidences of readmission and outpatient and total expenditures every 6 months during the observation period.
Participants had a mean of 21.1 systolic BP values measured during the course of the study. Estimated improvement to BP control was significantly higher 12 months after study completion in both the medication management (6.6%) and combined intervention groups (10.1%). At 18 months after completion, estimated BP control improvement was significantly higher in all three intervention arms compared with standard care (17.1% for behavioral, 20.2% for medication management and 20.4% for the combined arm).
At 18 months after trial completion, estimated mean systolic BP improved significantly in both the behavioral (5 mm Hg decrease) and combined intervention groups (5.5 mm Hg decrease) compared with the standard-care arm. In patients with insufficient BP control at baseline, estimated mean systolic BP was significantly lower among those receiving a combined intervention vs. standard care during and after the 18-month trial period.
Trends in cost and health care utilization were comparable between all four groups, with similar likelihood for readmission and estimated outpatient and total expenditures during and after the trial. Subgroup analyses limited to patients with poor baseline BP control yielded similar results.
“Even though the clinical benefits of this [hypertension self-management] intervention did not translate into economic benefits, this analysis addresses a question of great interest to payers,” the researchers wrote. “The business case for dissemination of interventions that are shown to be effective in randomized trials becomes even stronger if the economic benefits of intervention participation are sustained beyond immediate exposure to the intervention.”
Disclosure: One of the researchers reports receiving consultation funds from Pfizer and MeadWestVaco. Another researcher reports receiving consultation funds from Daiichi Sankyo, Novartis, Surgical Review Corp., and Takeda Pharmaceuticals, and owning stock in Amgen due to his wife’s employment.
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