Document Detail

An evidence-based review of patient-centered behavioral interventions for hypertension.
MedLine Citation:
PMID:  11567845     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: While behavioral interventions may be viewed as important strategies to improve blood pressure (BP), an evidence-based review of studies evaluating these interventions may help to guide clinical practice. METHODS: We employed systematic review and meta-analysis of the literature (1970-1999) to assess the independent and additive effects of three behavioral interventions on BP control (counseling, self-monitoring of BP, and structured training courses). RESULTS: Of 232 articles assessing behavioral interventions, 15 (4072 subjects) evaluated the effectiveness of patient-centered counseling, patient self-monitoring of BP, and structured training courses. Pooled results revealed that counseling was favored over usual care (3.2 mmHg [95% CI, 1.2-5.3] improvement in diastolic blood pressure [DBP] and 11.1 mmHg [95% CI, 4.1-18.1] improvement in systolic blood pressure [SBP]) and training courses (10 mmHg improvement in DBP [95% CI, 4.8-15.6]). Counseling plus training was favored over counseling (4.7 mmHg improvement in SBP [95% CI, 1.2-8.2]) and afforded more subjects hypertension control (95% [95% CI, 87-99]) than those receiving counseling (51% [95% CI, 34-66]) or training alone (64% [95% CI, 48-77]). CONCLUSIONS: Evidence suggests that counseling offers BP improvement over usual care, and that adding structured training courses to counseling may further improve BP. However, there is not enough evidence to conclude whether self-monitoring of BP or training courses alone offer consistent improvement in BP over counseling or usual care. The magnitude of BP reduction offered by counseling indicates this may be an important adjunct to pharmacologic therapy.
L E Boulware; G L Daumit; K D Frick; C S Minkovitz; R S Lawrence; N R Powe
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of preventive medicine     Volume:  21     ISSN:  0749-3797     ISO Abbreviation:  Am J Prev Med     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-09-24     Completed Date:  2001-11-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8704773     Medline TA:  Am J Prev Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  221-32     Citation Subset:  IM    
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
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MeSH Terms
Blood Pressure Determination
Evidence-Based Medicine
Hypertension / prevention & control,  therapy*
Middle Aged
Outcome Assessment (Health Care)
Patient Education as Topic / methods*,  organization & administration
Self Care
Grant Support
2T32PE10025/PE/BHP HRSA HHS; 5T32HL07024/HL/NHLBI NIH HHS; K08MH0178701/MH/NIMH NIH HHS; K240502643//PHS HHS

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

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