Clinical research study
The Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control

This work was presented in part as a poster at the Society of General Internal Medicine Annual Meeting in Pittsburgh, Pennsylvania, April 9, 2008.
https://doi.org/10.1016/j.amjmed.2008.12.022Get rights and content

Abstract

Background

Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C).

Methods

We evaluated patients from the Veterans Study to Improve the Control of Hypertension, a 2-year randomized controlled trial. Patients received either a hypertension self-management intervention delivered by a nurse over the telephone or usual care. Although the study focused on hypertension self-management, we compared changes in HbA1c among a subgroup of 216 patients with diabetes and LDL-C among 528 patients with measurements during the study period. Changes in these laboratory values over time were compared between the 2 treatment groups using linear mixed-effects models.

Results

For the patients with diabetes, the hypertension self-management intervention resulted in a 0.46% reduction in HbA1c over 2 years compared with usual care (95% confidence interval, 0.04%-0.89%; P = .03). For LDL-C, there was a minimal 0.9 mg/dL between-group difference that was not statistically significant (95% confidence interval, −7.3-5.6 mg/dL; P = .79).

Conclusions

There was a significant effect of the self-management intervention on the unintended target of HbA1c,but not LDL-C. Chronic disease self-management interventions might have “spill-over” effects on patients' comorbid chronic conditions.

Section snippets

Study Design

The V-STITCH trial was a 2-year cluster randomized control trial. The interventions occurred at 2 levels: provider and patient. Primary care providers were first randomized to receive either the computer decision support system focusing on hypertension medication management delivered at the point of care during patient visits or usual care without the decision support interface. Within each participating provider's primary care panel, patients with hypertension were then randomized to receive

Results for Patients with Diabetes: HbA1c

Of the 588 veterans enrolled in V-STITCH, there were 219 patients with diabetes (117 patients in the usual care arm and 102 patients in the intervention group). Of these, 216 patients had HbA1c measurements available for analysis and were included in the analysis. The Figure shows the patient flow from patient enrollment in the parent V-STITCH study, with the 2 cohorts identified for analysis in the present study. Patient characteristics for the patient sample with diabetes are shown in Table 1

Discussion

In a randomized controlled trial of a nurse-administered tailored self-management intervention to improve blood pressure control, we evaluated the effect of the intervention on the unintended targets of diabetes and cholesterol control over 2 years. There was a modest difference in glycemic control between intervention and usual care patients that was statistically significant. There was no evidence of an intervention effect on LDL-C. There did not appear to be any significant difference in the

Acknowledgements

This research is supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, investigator initiative grant 20-034. The first author was supported by Grant Number KL2 RR024127 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view

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    Funding: This research is supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, investigator initiative grant 20-034. The first author was supported by Grant Number KL2 RR024127 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR, NIH, or Department of Veterans Affairs.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and contributed to writing the manuscript.

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