Research Highlights

Patient Education Adds Critical Boost to Hypertension Management

September 21, 2006

This article was taken from VA Research Currents, September 2006.

In a study involving 1,341 veterans with hypertension at the Tennessee Valley VA Healthcare System, educational outreach to patients along with provider education was decidedly more effective than provider education alone in helping patients reach their blood pressure goals. The results appeared in the Aug. 1 Annals of Internal Medicine.

At the outset of the study, all the veterans were on one antihypertensive drug but still had blood pressure greater than 140/90 mm Hg, which is the target promoted in the 2003 seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7). The patients and their VA physicians were randomly divided into three groups. In the first group, doctors received an email with a link to the JNC 7 guidelines. Doctors in the second group received the guidelines email plus a onetime patient-specific computerized hypertension alert. In the third group, doctors received both interventions, and patients received a letter at home advocating medication adherence, lifestyle modification, and conversations with providers about treatment.

The mean baseline pressure for all three groups was 157/82. After six months, the only veterans who met the JNC7 goal were those who received the letter: Their mean pressure was 138/75, compared to 145/78 for those whose doctors received the guidelines link by email, and 146/76 for those whose doctors received the email plus the alert.

According to lead author Christianne L. Roumie, MD, MPH, and colleagues, the extra reduction in blood pressure among the patient-education group could potentially reduce heartfailure by 50 percent, cerebrovascular morbidity and mortality by 42 percent, and coronary heart disease by 14 percent.

"[The trial] shows the effectiveness of adding patient education to provide education in improving blood pressure control among veterans with uncontrolled essential hypertension," wrote the authors.

Roumie and colleagues note, as limitations of the study, that follow-up blood pressure measurements were missing for 27 percent of patients in the study. Furthermore, the study could not detect the mechanism by which patient education improved blood pressure control.