An evidence-based review of patient-centered behavioral interventions for hypertension

Introduction: While behavioral interventions may be viewed as important str ategies to improve blood pressure (BP), an evidence-based review of studies evaluating these interventions may help to guide clinical practice. Methods: We employed systematic review and meta-analysis of the literature (1970-1999) to assess the independent and additive effects of three behavio ral interventions on BP control (counseling, self-monitoring of BP, and str uctured training courses). Results: Of 232 articles assessing behavioral interventions, 15 (4072 subje cts) evaluated the effectiveness of patient-centered counseling, patient se lf-monitoring of BP, and structured training courses. Pooled results reveal ed that counseling was favored over usual care (3.2 mmHg [95% CI, 1.2-5.3] improvement in diastolic blood pressure [DBP] and 11.1 mmHg [95% CI, 4.1-18 .1] improvement in systolic blood pressure [SBP]) and training courses (10 mmHg improvement in DBP [95% CI, 4.8-15.6]). Counseling plus training was f avored over counseling (4.7 mmHg improvement in SBP [95% Cl, 1.2-8.2]) and afforded more subjects hypertension control (95% [95% CI, 87-99]) than thos e receiving counseling (51% [95% CI, 34-66]) or training alone (64% [95% Cl , 48-77]). Conclusions: Evidence suggests that counseling offers BP improvement over u sual care, and that adding structured training courses to counseling may fu rther improve BP. However, there is not enough evidence to conclude whether self-monitoring of BP or training courses alone offer consistent improveme nt in BP over counseling or usual care. The magnitude of BP reduction offer ed by counseling indicates this may be an important adjunct to pharmacologi c therapy.