Department of Family and Community Medicine, University of California, San Francisco (UCSF), 1001 Potrero Ave, Building 80/83, San Francisco, CA 94110, USA.
BMC Public Health. 2009 Dec 10;9:456. doi: 10.1186/1471-2458-9-456.
Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control.
METHODS/DESIGN: The randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n=150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction.
The present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention.
ClinicalTrials.gov identifier: NCT01013857.
尽管有许多降压药物可供选择，但仍有三分之二的高血压患者无法控制血压。这被认为是由于患者教育不佳、药物依从性差和“临床惰性”的综合作用。本试验评估了一种干预措施，该措施由健康指导、家庭血压监测和家庭药物滴定组成，旨在解决这三个导致高血压控制不佳的原因。
方法/设计：这项随机对照试验将纳入 300 名血压控制不佳的患者。参与者将从一家教学医院的初级保健诊所招募，该诊所主要服务于低收入人群。150 名干预组参与者将接受健康指导、家庭血压监测和家庭降压药物滴定，为期 6 个月。对照组（n=150）将在相同的时间内接受健康指导和家庭血压监测。一个被动对照组将接受常规护理。在基线、6 个月和 12 个月时进行血压测量。主要结局指标是 6 个月和 12 个月后收缩压的变化。测量的次要结局指标是舒张压的变化、不良事件和患者及提供者的满意度。
本研究旨在评估健康指导、家庭血压监测和家庭药物滴定的三管齐下方法是否能成功改善血压，如果是，这种效果是否能持续到干预期之外。
ClinicalTrials.gov 标识符：NCT01013857。
