Impact of Educational Mailing on the Blood Pressure of Primary Care Patients with Mild Hypertension


  • Received from the Department of Primary Care Research and Pharmacy (JSH, JS), Providence Health System; Oregon State University College of Pharmacy (JSH, DT); and Medical Data Research Center (NP), Portland, Ore.

Address correspondence and requests for reprints to Dr. Hunt: Providence Medical Group, 3601 SW Murray Boulevard, Suite 45, Beaverton, OR 97005 (e-mail:


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.