Date of Award
Open Access Thesis
Medical Doctor (MD)
Essential hypertension is the most common primary diagnosis in the US, with myriad and
serious sequelae inflicting significant morbidity upon individuals and economic losses
upon society. Estimates of adherence to prescribed medication regimens range from 20%
to 60%. Because hypertension is largely asymptomatic, patients may underestimate both
the benefits of adherence and the costs of nonadherence. This novel educational
intervention seeks to encourage adherent behavior by providing patients with a conscious
manifestation of their disease severity through manipulation of pressurized balls.
Randomized controlled pilot trial of patients under treatment for hypertension with SBP
≥140mmHg or DBP ≥90mmHg at index visit, selected by convenience sample at a VA
Primary Care Clinic. Baseline clinical, demographic, medication taking habits and
motivation data obtained by surveys and chart abstraction. All subjects received a short
talk on the dangers of hypertension. Intervention Group subjects simultaneously
squeezed rubber balls in each hand filled to air pressures differing by the same amount
that their current SBP exceeded 120mmHg. Followup medication taking habits,
motivation, medication possession ratios and blood pressure measurements were
determined by telephone survey, pharmacy and clinical records over 90-, 180-, 270- and
360-day time periods. Feasibility of a larger study was determined by structured
interviews with a physician and nurse who employed the intervention in clinical practice.
Thirty subjects were enrolled into Intervention and Control Groups of equal size.
Immediate motivational impact by 7-point scale significantly favored the Intervention
(6.3, p < 0.001 vs 4.3, p = 0.164). Change in self-reported adherence on an 8-point scale
at 90-days favored the Intervention but was not significant (0.5, p = 0.372 vs -0.1, p =
0.798). Change in 360-day medication possession ratio favored the Intervention and
approached significance (11.3%, p = 0.088 vs 0.7%, p = 0.934). Both Groups
demonstrated clinically relevant improvements in MAP with greater magnitude, duration
and significance for the Intervention Group through 360 days (-12.2mmHg, p = 0.008 vs
-6.0mmHg, p = 0.164). Larger improvements in adherence were significantly associated
with greater baseline motivation and immediate motivational impact from the
intervention while longer disease experiences were associated with less improvement.
Clinicians reported favorable reception from their patients and felt that the intervention
represented a simple and helpful tool that they would use in everyday practice.
The results of this pilot trial suggest that a novel, brief educational intervention designed
to provide a somatosensory manifestation of an otherwise asymptomatic disease process
may show promise in promoting adherent behavior and clinically useful reductions in
blood pressure in patients with poorly controlled hypertension. A larger study appears
feasible and is required to confirm and investigate the statistical significance of these
Steinberg, Justin M., "Pilot Study Of A Somatosensory Intervention To Improve Medical Adherence In Patients With Uncontrolled Hypertension" (2013). Yale Medicine Thesis Digital Library. 1845.