Impact of educational mailing on the blood pressure of primary care patients with mild hypertension

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Abstract
OBJECTIVE: To assess the effectiveness of mailed hypertension educational materials. DESIGN: Prospective, randomized, controlled single-blind trial. SETTING: Primary care practice-based research network in which 9 clinics located in Portland, Oregon participated. PARTICIPANTS: Patients with mildly uncontrolled hypertension as defined as a last blood pressure of 140 to 159/90 to 99 mmHg from query of an electronic medical record database. INTERVENTIONS: Patients randomized to intervention were mailed 2 educational packets approximately 3 months apart. The first mailer included a letter from each patient’s primary care provider. The mailer included a booklet providing an overview of hypertension and lifestyle modification and a refrigerator magnet noting target blood pressure. The second mailing also included a letter from the patient’s primary care provider, a second educational booklet focused on medication compliance and home blood pressure monitoring, and a blood pressure logbook. The control group consisted of similar patients receiving usual care for hypertension. MEASUREMENTS AND MAIN RESULTS: Patients from each group were randomly selected for invitation to participate in a study visit to measure blood pressure and complete a survey (intervention n=162; control n=150). No significant difference was found in mean blood pressure between intervention and control patients (135/77 mmHg vs 137/77 mmHg; P=.229). Patients in the intervention arm scored higher on a hypertension knowledge quiz (7.48 ± 1.6 vs 7.06 ± 1.6; P=.019), and reported higher satisfaction with several aspects of their care. No significant difference was seen in the prevalence of home blood pressure monitoring ownership or use. CONCLUSIONS: In patients with mildly uncontrolled hypertension, educational mailers did not yield a significant decrease in blood pressure. However, significant improvement in patient knowledge, frequency of home monitoring, and satisfaction with care were demonstrated.