Document Detail

Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients.
MedLine Citation:
PMID:  19920081     Owner:  NLM     Status:  MEDLINE    
Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2 x 2 randomized, controlled trial of physician intervention versus control and/or patient intervention versus control. Physician intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient intervention included 20 weekly group sessions followed by 12 monthly telephone counseling contacts and focused on weight loss, Dietary Approaches to Stop Hypertension dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic blood pressure at 6 months. Eight primary care practices (32 physicians) were randomized to physician intervention or control groups. Within those practices, 574 patients were randomized to patient intervention or control groups. Patient mean age was 60 years, 61% were women, and 37% were black. Blood pressure data were available for 91% of patients at 6 months. The main effect of physician intervention on systolic blood pressure at 6 months, adjusted for baseline pressure, was 0.3 mm Hg (95% CI: 1.5 to 2.2; P=0.72). The main effect of the patient intervention was 2.6 mm Hg (95% CI: 4.4 to 0.7; P=0.01). The interaction of the 2 interventions was significant (P=0.03); the largest impact was observed with the combination of physician and patient intervention (9.7 +/- 12.7 mm Hg). Differences between treatment groups did not persist at 18 months. Combined physician and patient interventions lowers blood pressure; future research should focus on enhancing effectiveness and sustainability of these interventions.
Laura P Svetkey; Kathryn I Pollak; William S Yancy; Rowena J Dolor; Bryan C Batch; Greg Samsa; David B Matchar; Pao-Hwa Lin
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Hypertension     Volume:  54     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-23     Completed Date:  2009-12-17     Revised Date:  2013-06-12    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1226-33     Citation Subset:  IM    
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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MeSH Terms
Community Health Services
Food Habits
Health Behavior
Hypertension* / epidemiology,  psychology,  therapy
Life Style*
Middle Aged
Motor Activity
Physician-Patient Relations*
Primary Health Care / methods*
Private Practice
Risk Factors
Risk Reduction Behavior
Weight Loss
Grant Support
Comment In:
Curr Hypertens Rep. 2010 Jun;12(3):149-51   [PMID:  20424947 ]
Hypertension. 2009 Dec;54(6):1202-3   [PMID:  19920080 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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