The effects of family involvement and practitioner home visits on the control of hypertension.

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Abstract
The effectiveness of 2 social support strategies designed to lower hypertensive patients'' blood pressure was compared to each other and to a control group (n = 63) receiving routine care in a randomized clinical trial extending over 2 yr. Group 1 (n = 99) received visits and had family members actively participate in their care through home blood pressure monitoring; Group 2 (n = 56) received home visits from nurses and pharmacists. All groups were predominantly Black. After the 1st yr of the trial, the proportion of patients with uncontrolled diastolic blood pressure (DBP) (.gtoreq. 95 mm Hg) had declined significantly for all 3 groups; no group showed a statistically significant advantage. During the last 6 mo. of the 2nd yr (after visiting had ended), both Groups 1 and 2 demonstrated clear superiority in DBP control over Group 3, achieving borderline statistical significance (P = 0.07) when multivariable analysis was performed to control for potential confounders. Supplementing routine care with periodic home visits produced an additional 21% of patients with well-controlled DBP, while involving family members plus visits produced a 17% improvement in the percentage of patients with DBP < 95 mm Hg. Neither support strategy was clearly more effective than the other over time. The efficacy of the interventions is discussed with respect to cost and feasibility of implementation.