Hypertension Research Today is a free monthly online journal that collates and summarizes the latest research about Hypertension, including details on symptoms, diagnosis, diet, treatment, causes.

The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial.

Bennett H, Laird K, Margolius D, Ngo V, Thom DH, Bodenheimer T

Department of Family and Community Medicine, University of California, San Francisco (UCSF), 1001 Potrero Ave, Building 80/83, San Francisco, CA 94110, USA. heather.bennett@ucsf.edu

BACKGROUND: Despite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control. METHODS/DESIGN: The randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n=150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction. DISCUSSION: The present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01013857.

Published 24 December 2009 in BMC Public Health, 9: 456.
Full-text of this article is available online (may require subscription).

Articles on Hypertension published 24 December 2009:

Sympathetic activity is not increased in L-NAME hypertensive rats.   Am J Physiol Regul Integr Comp Physiol, 298(1): R89-95.

The role played by the sympathetic drive in the development of N(G)-nitro-l-arginine methyl ester (l-NAME)-induced hypertension is not firmly established. Therefore, the present study was undertaken in conscious rats in which hypertension was induced by treatment with l-NAME over the course of either 2 or 14 days. Mean arterial pressure (MAP) was measured via a catheter placed in the femoral artery, drugs were administered via a cannula placed in the femoral vein, and renal sympathetic nerve ... [Abstract] [Full-text]

Renal NOS activity, expression, and localization in male and female spontaneously hypertensive rats.   Am J Physiol Regul Integr Comp Physiol, 298(1): R61-9.

The goal of this study was to examine the status of the renal nitric oxide (NO) system by determining NO synthase (NOS) isoform activity and expression within the three regions of the kidney in 14-wk-old male and female spontaneously hypertensive rats (SHR). NOS activity, and NOS1 and NOS3 protein expressions and localization were comparable in the renal cortex and outer medulla of male and female SHR. In contrast, male SHR had significantly less NOS1 and NOS3 enzymatic activity (0 +/- 5 and 53 ... [Abstract] [Full-text]

The heme oxygenase system attenuates pancreatic lesions and improves insulin sensitivity and glucose metabolism in deoxycorticosterone acetate hypertension.   Am J Physiol Regul Integr Comp Physiol, 298(1): R211-23.

Recent clinical reports indicate that impaired glucose tolerance is a common phenomenon in primary aldosteronism. Aldosterone stimulates NF-kappaB and activating protein-1 (AP-1) to cause oxidative injury. Elevated oxidative stress impairs insulin signaling. We recently showed that the heme oxygenase (HO) system lowers blood pressure (BP) in deoxycorticosterone-acetate (DOCA)+salt hypertension, a model of primary aldosteronism. However, the effect of the HO system on insulin sensitivity in this ... [Abstract] [Full-text]

Articles on Hypertension published 21 December 2009:

Simvastatin and tempol protect against endothelial dysfunction and renal injury in a model of obesity and hypertension.   Am J Physiol Renal Physiol, 298(1): F86-94.

Obesity and hypertension are risk factors for the development of chronic kidney disease. The mechanisms by which elevated blood pressure and fatty acids lead to the development of renal injury are incompletely understood. Here, we investigated the contributions of cholesterol and oxidative stress to renal endothelial dysfunction and glomerular injury in a model of obesity and hypertension. Male Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) were fed a normal diet, a high-fat ... [Abstract] [Full-text]

Intrarenal mouse renin-angiotensin system during ANG II-induced hypertension and ACE inhibition.   Am J Physiol Renal Physiol, 298(1): F150-7.

Angiotensin-converting enzyme (ACE) inhibition (ACEi) ameliorates the development of hypertension and the intrarenal ANG II augmentation in ANG II-infused mice. To determine if these effects are associated with changes in the mouse intrarenal renin-angiotensin system, the expression of angiotensinogen (AGT), renin, ACE, angiotensin type 1 receptor (AT(1)R) mRNA (by quanitative RT-PCR) and protein [by Western blot (WB) and/or immunohistochemistry (IHC)] were analyzed. C57BL/6J male mice (9-12 wk ... [Abstract] [Full-text]

Articles on Hypertension published 18 December 2009:

Upregulation of Na+ and Ca2+ transporters in arterial smooth muscle from ouabain-induced hypertensive rats.   Am J Physiol Heart Circ Physiol, 298(1): H263-74.

Prolonged ouabain administration (25 microg kg(-1) day(-1) for 5 wk) induces "ouabain hypertension" (OH) in rats, but the molecular mechanisms by which ouabain elevates blood pressure are unknown. Here, we compared Ca(2+) signaling in mesenteric artery smooth muscle cells (ASMCs) from normotensive (NT) and OH rats. Resting cytosolic free Ca(2+) concentration ([Ca(2+)](cyt); measured with fura-2) and phenylephrine-induced Ca(2+) transients were augmented in freshly dissociated OH ... [Abstract] [Full-text]

Articles on Hypertension published 16 December 2009:

Sociodemographic, lifestyle, and medical risk factors for visual impairment in an urban asian population: the singapore malay eye study.   Arch Ophthalmol, 127(12): 1640-7.

OBJECTIVE: To describe the associations between sociodemographic, lifestyle, and medical risk factors and visual impairment in a Southeast Asian population. METHODS: Population-based cross-sectional study of 3280 (78.7% response rate) Malay Singaporeans aged 40 to 80 years. Participants underwent a standardized interview, in which detailed sociodemographic histories were obtained, and clinical assessments for presenting and best-corrected visual acuity. Visual impairment (logMAR > 0.30) was ... [Abstract] [Full-text]

Long-term exposure to methylmercury and its effects on hypertension in Minamata.   Environ Res, 110(1): 40-6.

Recent studies suggest potential adverse effects of methylmercury exposure on cardiovascular disease, although the evidence of association with hypertension is still inconsistent. Therefore, we evaluated the effects of methylmercury exposure on hypertension in Minamata. We used data derived from the 1971 population-based survey in Minamata and neighboring communities. We also utilized data on hair mercury content of the participants (derived from a 1960 investigation). We adopted two exposure ... [Abstract] [Full-text]

© 2004-2010 Hypertension Research Today. All Rights Reserved.