Abstract 1301: Hypertension Improvement Project (HIP): Randomized Trial of Quality Improvement for Physicians and Lifestyle Modification for Patients
Despite widely publicized hypertension treatment guidelines for physicians (MDs) and lifestyle recommendations for patients (Pts), blood pressure (BP) control rates remain low. In community-based primary care clinics, we performed a nested, 2x2 randomized, controlled trial of a physician intervention (MD-I) vs. control (MD-C) and/or patient intervention (Pt-I) vs. control (Pt-C). MD-I included internet-based training, self-monitoring, and quarterly feedback reports. Pt-I included 20 weekly group sessions followed by 12 monthly phone counseling contacts, focused on weight loss, DASH dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic BP at 6 months. Eight primary care practices (32 MDs) were randomized. Within those practices, 574 patients were randomized to Pt-I or Pt-C. Patients’ mean age was 60 years, 61% female, 37% African American. BP data were available for 91% of patients at 6 months and 88.5% at 18 months. The main effect of MD-I on SBP at 6 months, adjusted for baseline SBP, was 0.3 mmHg (95% CI −1.5 to 2.2; p=0.72). The main effect of the Pt-I was −2.6 mmHg (95% CI −4.4, −0.7; p=0.01). The interaction of the 2 treatment groups was significant (p=.03), reflecting that the largest impact of the intervention was observed in the group receiving both the patient and physician interventions (−9.7 +− 12.7 mm Hg). Differences between treatment groups did not persist at 18 months, partly because the MD-I and Pt-C patients improved. In conclusion, Pt-I lowered BP, and MD-I enhanced that effect. Given the potential impact of lifestyle modification on BP and the apparent role that doctors play in encouraging healthy behaviors, future research should focus on enhancing efficacy and sustainability of both patient and provider interventions.