CoCo trial: Color-coded blood pressure Control, a randomized controlled study

Background: Inadequate blood pressure (BP) control is a frequent challenge in general practice. The objective of this study was to determine whether a color-coded BP booklet using a traffic light scheme (red,  180 mmHg systolic BP and/or  110 mmHg diastolic BP; yellow,  140–180 mmHg systolic BP or  90–110 mmHg diastolic BP; green,  140 mmHg systolic BP and  90 mmHg diastolic BP) improves BP control and adherence with home BP measurement. Methods: In this two-group, randomized controlled trial, general practitioners recruited adult patients with a BP  140 mmHg systolic and/or  90 mmHg diastolic. Patients in the control group received a standard BP booklet and the intervention group used a color-coded booklet for daily home BP measurement. The main outcomes were changes in BP, BP control (treatment goal  140/90 mmHg), and adherence with home BP measurement after 6 months. Results: One hundred and twenty-one of 137 included patients qualified for analysis. After 6 months, a significant decrease in systolic and diastolic BP was achieved in both groups, with no significant difference between the groups (16.1/7.9 mmHg in the intervention group versus 13.1/8.6 mmHg in the control group, P = 0.3/0.7). BP control (treatment target  140/90 mmHg) was achieved significantly more often in the intervention group (43% versus 25%; P = 0.037; number needed to treat of 5). Adherence with home BP measurement overall was high, with a trend in favor of the intervention group (98.6% versus 96.2%; P = 0.1) Conclusion: Color-coded BP self-monitoring significantly improved BP control (number needed to treat of 5, meaning that every fifth patient utilizing color-coded self-monitoring achieved better BP control after 6 months), but no significant between-group difference was observed in BP change. A markedly higher percentage of patients achieved BP values in the normal range. This simple, inexpensive approach of color-coded BP self-monitoring is user-friendly and applicable in primary care, and should

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