The Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control

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 (HbA(1c)) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c), but not LDL-C. Chronic disease self-management interventions might have "spillover" effects on patients' comorbid chronic conditions. Published by Elsevier Inc. The American Journal of Medicine (2009) 122, 639-646