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Svetkey LP, Pollak KI, Yancy WS Jr., et al.: HypertensionImprovement Project: randomized trial of quality improve-ment for physicians and lifestyle modification for patients.Hypertension 2009, 54:1226–1233.Rating†Of importance.IntroductionEffective hypertension management is still a clinicalchallenge. The prevalence of hypertension continues torise in the western world, despite awareness of its seriouscardiovascular consequences [1]. Adequate blood pressure(BP) control is of clear public health importance, butrecent reports indicate that as many as two thirds of thosebeing treated for hypertension in the United States donot have BP under proper control [2]. To address thisimportant public health issue, a large study evaluating theefficacy of a nonconventional, two-level (patient andphysician) management strategy for hypertension man-agement was timely.AimsUsing a large, prospective, and randomized community-based trial, the Hypertension Improvement Project (HIP)recently reported their findings on the comparative effec-tiveness of 1) physician intervention, 2) patient interven-tion, or 3) the combination of such interventions [3].MethodsPublished in the journal Hypertension in November 2009,the HIP study demonstrated differences in BP-loweringeffects between patient intervention, physician intervention,and combined interventions. The patient-intervention strategyconsisted of 20 weekly group sessions over 6 months,conducted by experienced behavioral personnel. The focusof the intervention was the use of motivational interviewingtechniques to assist patients toward weight loss if overweight,to increase awareness of dietary approaches to controlling BP(with the Dietary Approaches to Stop Hypertension [DASH]dietary pattern [4]), to increase moderate-to-vigorous physicalactivity, and to reduce sodium intake and moderate alcoholintake. Additionally, the patient intervention aimed toencourage adherence to the antihypertensive medicationregimen. In short, this patient-intervention regimen wasdesigned to “promote frequent self-monitoring, feedback,goal setting, and social support and used motivationalinterviewing techniques” [3].The physician intervention strategy consisted of twotraining modules for the clinicians: one addressed theSeventh Joint National Committee on Prevention, Detec-tion, Evaluation and Treatment of High Blood Pressure(JNC-7) guidelines [5], and the second addressed lifestylemodification for BP control. Additionally, each physician in

Synergistic Physician and Patient Behavioral Interventions as Management Strategy for Effective Population-Based Hypertension Control