Table 4.

Intervention Arm Module Content – Medium (RN) and High (pharmacist) Resource Levels^*

Topic	Module Content
Opening Module/Medication Management [delivered during each call]	Review of currently prescribed BP medication, assessing if the participant is familiar with the purpose of the medication, and whether there have been any changes in the use of the their hypertensive medications. If the patient does not understand the purpose of their hypertension medication in any encounter or how to take the medication, the interventionist explains the purpose of each medication prescribed for that individual. If the patient reports that there has been a change in their BP medications, the interventionist queries if their PCP is aware of the change. If not, the interventionist discusses the importance of informing their PCP of changes in their BP medication regimens.
Adverse Effects of Antihypertensive Medication [delivered during each call]	Patients are queried at every scheduled phone call about any specific BP medication side effects they may have. If a patient is having a hypertension-medication related adverse effect, the interventionist discusses the problem with the patient. The interventionist also reminds the patient to discuss any adverse effects with their PCP. Any potentially life threatening adverse effect is reported immediately to the PCP. The goal is to prevent medication nonadherence by informing patients of common adverse effects and help to facilitate medication change when necessary.
Memory	Patients who report they have difficulties remembering to take their medication are provided various mnemonic strategies such as setting an alarm or using a weekly pillbox.55 The interventionist conveys the need and importance of taking BP medication consistently and in a timely manner.
Knowledge/Risk Perception	All patients will receive information and counseling from the interventionist on the importance of maintaining BP control by underscoring the association between hypertension and diseases that come about from poor control. Counseling is tailored to individuals who are diabetic,56–58 African American,59, 60 recently diagnosed with hypertension, and/or have hypertensive relatives61, 62 because these factors confer specific risks for worse health outcomes.
Participatory Decision- Making and Patient- Provider Communication	Patients identified as having poor provider relationships receive information on ways to empower patients to interact more productively with their providers.
Diet	Patients are asked to choose a topic of interest for them for information on low sodium diet, healthy carbohydrates, or heart healthy choices and portion control. Patients are also asked to talk about foods they eat in a typical day. There is a discussion of sodium and sources of where high levels of sodium may be found, followed by having individuals think of ways they can reduce their sodium intake. The interventionist discusses how individuals can determine the sodium contents of food and remind patients of how much sodium they should ingest in a day. This material includes the Dietary Approaches to Stop Hypertension (DASH) diet, which has been found to lower BP.63–65
Weight	The interventionist emphasizes the importance of maintaining a healthy weight and queries individuals as to what stage they are in terms of initiating weight loss (not ready, thinking about it, preparing, or taking action). Weight loss information is then tailored to individuals’ readiness to change.
Exercise	The interventionist reviews the benefits of exercise and assesses current physical activity and whether individuals have increased their level of physical activity since enrolling in the study. The interventionist determines their exercise activity readiness to change and information is then tailored to the patient’s readiness. The interventionist also helps the individual to determine the intensity level of their planned activities as well as setting realistic goals.
Social and Medical Environment/Access to Care.	If barriers to care (e.g., lack of transportation, medical costs, social isolation) are identified, the interventionist assists patients in identifying and using available resources to overcome barriers (e.g., community resources, inexpensive medications).
Stress, Mental Health, Insomnia and Sleep Apnea.	Patients are asked about their knowledge of the relationship between stress and hypertension as well as how individuals know when they are stressed. The interventionist provides some suggestions on how to potentially reduce stress, monitor their sleep habits and, if appropriate, be referred to the sleep apnea clinic. Among individuals who screen positive on Patient Health Questionnaire (PHQ)-266, 67 [2 item screening instrument for depression], the interventionist will discuss various treatments available (e.g., medication, therapy), the importance of seeking treatment, and how to access these resources as a VA patient. Patients are asked the Berlin Questionnaire (for sleep apnea) during the 6 month study visit to identify patients at risk for the sleep apnea syndrome. The questionnaire consists of 3 categories related to the risk of having sleep apnea. Patients can be classified into High Risk or Low Risk based on their responses to the individual items and their overall scores in the symptom categories. High Risk patients trigger a module where the interventionist discusses the result and encourages participant to discuss a referral for diagnostic polysomnogram (PSG) evaluation for sleep apnea with their PCP.
Smoking	Among smokers, the interventionist highlights the benefits of smoking cessation for those who report they are current smokers. The interventionist then determines the individual’s stage in terms of considering smoking cessation.
Closing Module [delivered during each call]	The interventionist asks patients to report their most recent blood pressure. If they are not aware of it, the interventionist reiterates the importance of knowing one’s blood pressure. For those patients who know their blood pressure, the interventionist provides feedback for those with inadequate blood pressure control and further reinforcement for those with adequate blood pressure control.

BP - blood pressure; PCP - primary care provider

^*LPN calls provide knowledge-based information on these topics, with the exception of diet, exercise, mental health, and sleep apnea based on the schedule in Table 5.