Telephone health coaching intervention ineffective for improving outcomes for hypertension

1. A randomized trial for a blood pressure (BP) self-management program, involving 6 months of telehealth coaching for hypertensive young adults, found no difference in systolic or diastolic BP at 6 months and 12 months follow-up.

2. There was greater frequency of home BP monitoring in the intervention group at 6 and 12 months, with decreased sodium intake and increased physical activity at 6 months, but not 12 months.

Evidence Rating Level: 1 (Excellent)

An estimated 20-30% of young adults aged 18-39 have hypertension (HTN), with fewer than half of them attaining adequate blood pressure (BP) control. As there are few trials examining interventions for BP self-management in this population, the MyHEART program was created to encourage BP monitoring, promote lifestyle changes, and improve understanding of antihypertensives, amongst young adults with HTN. This current randomized controlled trial compared changes in BP at 6 and 12 months, between young adults enrolled in MyHEART and those undergoing usual care. The study population consisted of adults aged 18-39 years recruited from 2 healthcare authorities in the Midwestern United States, with at least 2 medical office visits coded for HTN. These individuals were randomized 1:1 to care as usual or the 6-month MyHEART program. This program involves evidence-based self-management strategies, such as telehealth coaching with adult education specialists, individualized HTN educational content, and monitoring BP at home. These participants received 20 minute calls every 2 weeks from coaches who had a background in motivational interviewing. In total, there were 316 patients (159 in control and 157 in intervention), with a median (IQR) age of 35 (31-37) years. At baseline, the systolic BP (133.00 [SD 12.67] mmHg for control; 132.59 [11.36] mmHg for intervention) and the diastolic BP (87.04 [81.6] mmHg for control; 86.45 [7.76] mmHg for intervention) were comparable between groups. The study showed that at 6 months and at 12 months, there were no differences in 24-hour ambulatory systolic or diastolic BP between the groups: At 6 months, the systolic BPs were 130.69 [13.99] and 128.14 [11.36] mmHg for control and intervention respectively (p = 0.12), and at 12 months, they were 129.47 [14.71] and 128.54 [11.95] for control and intervention respectively (p = 0.59). However, in both groups, there were significant decreases from baseline in systolic and diastolic BPs at 6 and 12 months. As well, there were significant differences between the groups in monitoring home BP at least once weekly (64% for intervention vs 9.6% for control at 6 months, p < 0.001; 34.9% for intervention vs 8.9% for control at 12 months, p < 0.001). There were also significant differences between groups in sodium intake and physical activity at 6 months, but not at 12 months. Overall, this study showed that the MyHEART program was not associated with differences in BP between control and intervention at 6 and 12 month follow-up, but did demonstrate differences in lifestyle changes, such as home BP monitoring.

Click to read the study in JAMA Network Open

Image: PD

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