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Title of Journal: J GEN INTERN MED

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Abbravation: Journal of General Internal Medicine

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Springer US

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DOI

10.1007/bf02242985

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ISSN

1525-1497

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A Successful Multifaceted Trial to Improve Hyperte

Authors: Karen L Margolis Stephen E Asche Anna R Bergdall Steven P Dehmer Michael V Maciosek Rachel A Nyboer Patrick J O’Connor Pamala A Pawloski JoAnn M SperlHillen Nicole K Trower Ann D Tucker Beverly B Green
Publish Date: 2015/05/08
Volume: 30, Issue: 11, Pages: 1665-1672
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Abstract

The study was a preplanned secondary analysis of a clusterrandomized clinical trial Eight clinics in an integrated health system were randomized to provide usual care to their patients n = 222 and eight were randomized to provide a telemonitoring intervention n = 228Path analytic models estimated indirect effects of the seven potential mediators of intervention effect defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months The potential mediators were change in home BP monitor use number of BP medication classes adherence to BP medications physical activity salt intake alcohol use and weightThe difference in change in systolic BP was 113 mmHg The multivariable mediation model explained 47  53 mmHg of the intervention effect Nearly all of this was mediated by two factors an increase in medication treatment intensity 24  and increased home BP monitor use 19  The other five factors were not significant mediators although medication adherence and salt intake improved more in the intervention group than in the usual care groupMost of the explained intervention effect was attributable to the combination of selfmonitoring and medication intensification High adherence at baseline and the relatively low intensity of resources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP

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