Findings seen in randomized trial of highly disadvantaged patients with uncontrolled HTN
MONDAY, Oct. 7, 2019 (HealthDay News) — A patient-centered behavioral economics intervention only yields short-term benefits for blood pressure (BP) control in a highly disadvantaged population, according to a study published online Sept. 12 in the Journal of General Internal Medicine.
Martin Shapiro, M.D., Ph.D., a professor of medicine at Weill Cornell Medicine in New York City, and colleagues assessed the impact of a six-month intervention combining short-term financial incentives with promotion of intrinsic motivation on BP control among highly disadvantaged patients. The intervention included incentives for measuring home BP, recording medication use, BP improvement, and achieving target BP values with counseling linking hypertension control efforts to participants’ personal reasons to stay healthy. The analysis included 207 adults (98 percent African American or Latino) with uncontrolled hypertension attending Federally Qualified Health Centers who were randomized to the intervention or usual care.
The researchers found that at six months, the rates of achieving systolic BP <140 mm Hg were 57.1 percent for the intervention group and 40.2 percent for control participants (adjusted odds ratio [aOR], 2.53 [95 percent confidence interval, 1.13 to 5.70]), 79.8 versus 70.1 percent for achieving diastolic BP <90 mm Hg (aOR, 2.50 [0.84 to 7.44]), and 53.6 versus 40.2 percent for achieving both targets (aOR, 2.04 [0.92 to 4.52]). However, at 12-month follow-up, the groups did not differ significantly with regard to these three measures: 39.5 versus 35.0 percent for SBP (aOR, 1.20 [0.51 to 2.83]), 68.4 versus 75.0 percent for DBP (aOR, 0.70 [0.24 to 2.09]), and 35.5 versus 33.8 percent for both (aOR, 1.03 [0.44 to 2.42]). At neither six nor 12 months were there significant differences between the groups for changes in absolute SBP and DBP. In an exploratory post hoc analysis, the investigators found that the intervention benefit only occurred among individuals whose providers intensified their regimens.
“Future research should evaluate combined patient/provider strategies to enhance such interventions and sustain their benefit,” the authors write.
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