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.
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.
aCenter for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC
bDepartment of Medicine, Division of General Internal Medicine, Duke University, Durham, NC
cDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NC
dDepartment of Psychiatry and Behavioral Sciences & Center for Aging and Human Development, Duke University, Durham, NC
Requests for reprints should be addressed to Benjamin J. Powers, MD, Center for Health Services Research in Primary Care, Hock Plaza, 2424 Erwin Road, Suite 1105, Durham, NC 27705
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.
ABSTRACT
