Skip to main content

The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial



Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries.


The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness.


The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.


Data reported from the World Health Organization (WHO) showed that hypertension caused approximately 13% of annual deaths worldwide in the year of 2004. Death rates due to hypertension in low and middle income countries are higher compared to high income countries [1, 2]. Based on a report by WHO's South East Asia, hypertension prevalence ranges from 8% to 40% in the region. Hypertension is also a major non communicable disease in Malaysia. It is estimated that 5.8 million people or 21% of the entire Malaysian population suffer from hypertension and there was an increasing trend over the past decade [3].

Despite availability of effective anti-hypertensive medications at affordable cost, the control of hypertension is still a major issue in both developed and developing countries in Asia [4]. Lifestyle modification which mainly includes dietary adjustment, exercise and weight management can be used as a non-pharmacological intervention in managing chronic non communicable diseases [5]. According to previous evidence, life style modification is a promising tool for prevention and control of hypertension [69].

Patients' non-cooperation or lack of compliance to pharmacological and non-pharmacological treatment are identified as key barriers in hypertension management [10]. A review by Glynn et al (2010) concluded that self-monitoring of blood pressure and regular follow up increased adherence to medication as well as blood pressure control. It was supported by several studies that self-management of hypertensive patients which includes home blood pressure monitoring aids in blood pressure reduction [1113].

The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. To our knowledge, this is the first study to explore the effect of peer support home blood pressure monitoring rather than an individual based approach. The outcome from this study potentially may assist in development of future public health intervention in a resource limited setting.



Objectives of this study are to investigate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, dietary intake, physical activity and fitness during asix-month intervention period. Moreover, we aim to assess whether these effects are sustained more than six months after the intervention has ended.

Study design and setting

The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. There are six community housing complexes in the study area. Of these four housing complexes will be randomly selected and allocated (1:1) to the intervention and control arm (Figure 1).

Figure 1
figure 1

Flow of participants in the intervention and control arm

The intervention group will receive training on self-measurement of blood pressure, health coaching on healthy diet, training for indoor exercise activities and the use of Body Mass Index (BMI) calculator. Participants in the control group will receive a BMI calculator and a pamphlet developed by the study team which includes brief information on hypertension, healthy diet and physical activity.

Residents of the selected community housings who were diagnosed as having (stage 1 to stage 3) hypertension by medical professionals will be recruited as participants for the study. The potential participants will be identified based on the household survey data which was carried out by the 'PARTNER' study team from the University of Malaya. This survey was a cross-sectional design and conducted between February to November 2012. Altogether, 833 households were recruited from total 4726 households of four Community Housing Projects by using simple random sampling method. From 833 households, 431 individuals with hypertension were identified.

Inclusion and exclusion criteria of the study are as follows.

Inclusion criteria

Adults aged 18 years and above will be eligible for the study if they have been diagnosed as having hypertension (stage 1 to 3) by medical professionals, Malaysian citizen, able to speak Malay (national language) or/and English, willing to participate in all aspects of the intervention and fit to do exercise. Participants who can do daily activities without limitations are defined as "Fit to do exercise". The potential participants will be screened by Physical Activity Readiness Questionnaire (PAR-Q) whether they are fit to do exercise or need further consultation with physician[14].

Exclusion criteria

Residents who are pregnant, participants of other clinical trials or plan to leave the area before end of the study period will be excluded.

Sample size calculation and recruitment

The sample size was calculated by assuming p < 0.05 as the significance level, 80% power and 1 to 1 as the ratio of unexposed to expose in sample. The calculation was carried by using the OpenEpi version 2.3.1 [15]. On the assumption of an SD of 15 mmHg and 30% drop out, a sample size of 160 participants per group is required to detect the effect size of systolic blood pressure 5.4 mm Hg. The effect size used to calculate the sample size was based onthe result of a previous similar study[16].

Universal sampling method will be used to recruit the study participants. The 431 residents of the selected community housing complexes who were diagnosed as (stage 1 to 3) hypertension will be invited to the study. We will take all participants which fit with inclusion criteria and willing to participate to the study so that actual participants may be more than calculated sample size.


The intervention is developed based on Social Cognitive Theory which includes social support, self-regulation and self-efficacy [17]. There will be three main components in the intervention i) Peer support for home blood pressure monitoring, ii) Face to face health coaching on healthy diet iii) Demonstration and training for indoor home based exercise activities.

Peer support groups, consisting of five persons per group will be formed based on the proximity of the residences. An Omron digital blood pressure monitor (HEM-7111) will be distributed to each group and participants will be trained by a state registered nurse on how to measure blood pressure and record the blood pressure reading in a log book.

Dietary assessments of individual participants will be conducted by three dietitians using 7 days diet histories. These dietitians will be randomly assigned to participant groups to assess the food intake. The same principal dietitian will conduct six sessions of health coaching to the participants in the group. The content of health coaching will include diet modification according to the DASH (Dietary Approaches to Stop Hypertension)diet [7, 18] and reduction of sodium intake. The sodium reduction approach that will be used in this study is by educating the participants to use herbs and spices in their cooking and by reducing the table salt usage. Healthy cooking demonstration and practices of reading food label will also be included in the sessions of health coaching. High in sodium foods will be encouraged to be minimised. The health coaching materials to the intervention groups are the same whilst control will receive healthy diet leaflet at the beginning of the study. After completing the intervention, the three dietitians will do the post intervention dietary assessment using the 7 days diet histories.

Exercise demonstrations and training will be conducted by a certified trainer from the sport medicine department. The exercise demonstration will focus on strengthening and flexibility exercise. The participants will be recommended to do low to moderate level physical activity and exercise minimum 150 minutes per week. Brisk walking will be also recommended as aerobic exercise. An exercise compact disc (CD) will be provided to the study participants as a guide to do exercise on their own. The participants will also be trained to record their physical activity in a log book. A Body Mass Index (BMI) calculator will be provided to help them to check their own BMI.

Study tools and measurements

The following tools and measurements will be used to evaluate the effect of the intervention and compliance of the participants regarding lifestyle modification included in the intervention. The measurements will be taken at baseline, six months and twelve months for both groups.

Blood pressure measurement

Systolic and diastolic arterial blood pressure will be measured by using Omron Automated Blood Pressure Monitor HEM-7211 which is recommended by the Malaysian Hypertension Association. The arterial blood pressure measurement will be done according to the standardized procedure recommended by World Health Organization [19]. After a rest of ten minutes, two sitting blood pressure will be taken 5 minutes apart on either arm. The average of these two readings will be used as the BP reading of the individual.

Questionnaire booklet

A booklet of self-administered questionnaires will be provided for the participants to be completed. Questionnaires include i) Socio-demographic characteristics, ii) Knowledge, awareness and treatment of hypertension, and iii) Global Physical Activity Questionnaire (GPAQ) and, iv) Socio Cognitive variables.

The questionnaire for knowledge, awareness and treatment of hypertension is adapted from the questionnaire developed by World Health Organization [20]. The questionnaire has been translated into Malay version. Face validity has been conducted with 30 participants. The results from the pilot testing showed that contents of the questionnaire are understandable to the participants and can be applied for targeted population.

GPAQ is a tool developed by World Health Organization. It consists of 16 questions to measure the level of physical activity of each individual. The total score of physical activity will be expressed as METs (Metabolic Equivalents). One MET is defined as the energy cost of sitting quietly, and is equivalent to a caloric consumption of 1 kcal/kg/hour. In order to calculate a person's overall energy expenditure, 4 METs will get assigned to the time spent in moderate activities, and 8 METs to the time spent in vigorous activities [21]. The GPAQ questionnaire has been translated and validated into Malay version [22]

Dietary assessment

7 Days Diet History is chosen for dietary assessment. The tool has been pre-tested with 20 subjects from the community housing complexes, 10 with hypertension and 10 without hypertension. The 7 Days Diet History will be conducted by trained dietitians. A diet history flip chart will be used as a supplementary tool to assist the study participants during the dietary evaluation and to help in estimating the portion size of the foods consumed [23].

Physical evaluation

Height will be measured without socks and shoes by using a calibrated vertical Seca Portable 217 Stadiometer, to the nearest millimetre. Weight will be measured with light clothing using a Seca 813 digital electronic scale, to the nearest decimal fraction of kilogram. Body mass index (BMI) will be calculated as weight in kilograms divided by the square of height in meters. Body fat composition will be measured using a Tanita portable Body Composition Analyzer SC-240 MA. Waist circumference (WC) and hip circumference (HC) will be measured with a non-elastic Seca measuring tape, to the nearest millimetre. Position of waist circumference measurement will be done at a level midway between the lower rib margin and highest point of iliac crest with the tape all around the body in horizontal position [24]. The hip circumference will be measured at the widest point over the buttock yielding the maximum circumference of the buttocks. For women, this is usually at groin level and for men, it is normally about 2-4 inches below the naval/umbilicus.

The "six minute walk test" will be conducted to measure cardiovascular endurance. The six minute walk test is a sub maximal measure of aerobic capacity [2527]. A calibrated Jamar hand dynamometer will be used to perform the hand grip strength test. Participants will be asked which the dominant hand is. The first test will be performed with dominant hand and then, with non-dominant hand. Three sets of test will be repeated alternatively for both hands [28, 29]. The strength of the hand grip will be recorded as kilogram of force.

Follow up and outcome measurement

The follow up will be at six months and twelve months for both intervention and control groups. The GPAQ questionnaire survey, 7 days diet history, blood pressure measurement and physical evaluation will be conducted at baseline, six months and twelve months. The log book kept by participants in the intervention group will be checked for completeness and errors after one month of the intervention and the record will be taken at three, six, nine and twelve months in order to check the compliance of self-blood pressure monitoring and home-based exercise, and whether they measured their blood pressured once a week or not.

The primary outcomes will be systolic and diastolic blood pressure measured at zero month (enrolment), six months (end of intervention period), and twelve months (maintenance period). Secondary outcome measures include some Social Cognitive Theory variables related to self-efficacy and self-regulatory such as practice of self-blood pressure monitoring, and adherence of exercise. Other secondary outcomes will be dietary intake, level of physical activity and physical fitness in term of both cardio vascular endurance and muscle strength.

Data management and analysis

The data analysis will be done by using Stata software (version 11: StataCorp). Bivariate analysis such as Chi-square tests (for dichotomous and categorical variables), t test and ANOVA (for continuous and normally distributed variables) and Mann-Whitney-U test (for continuous variable with skewed distribution) will be applied to compare the two groups with respect of socio-demographic characteristics, number of clinic visits, practice of self-blood pressure monitoring, blood pressure at the time of enrolment, dietary intake, level of physical activity and fitness.

The primary outcome, change in systolic and diastolic blood pressure at six months and twelve months will be compared between and within the groups by using t test and ANOVA. If there are some differences in group characteristics, it will be adjusted by performing multivariate analysis of variance (MANOVA).

Since the secondary outcomes such as numbers of self-blood pressure monitoring, dietary intake, body composition (BMI, fat percentage, waist and hip circumference ratio), level of physical activity and physical fitness are also continuous variables, these will be examined as per primary outcome. The normality of the continuous variables will be checked before analysis and proper transformation will be done if the data is not normally distributed. The level of statistical significance will be set at p < 0.05.

In order to calculate nutrient intake, Nutritionist Pro™ Diet Analysis software will be used to analyse the diet record. It will focus mainly on energy, protein, fat, carbohydrate, sodium, dietary fibre and others. Based on the 7 days diet histories, the average energy consumed with macronutrients (e.g: Energy intake (kcal), protein (g), fat (g), saturated fat (g) and others) and micronutrients (e.g: calcium (mg), iron (mg), vitamins and minerals) value will be calculated. All nutrient intakes will be transferred to the Stata software for final data analysis.

Ethical consideration

Ethical approval was obtained from the Medical Ethics Committee, University Malaya Medical Centre (Reference Number: 944.18). The trial was registered at Iranian Clinical Trial registry (Reference Number: IRCT2013030512705N1). The control groups will be receiving all components of intervention after completion of the study.


Hypertension is a major contributor to the growing global pandemic of cardiovascular diseases and stroke. It is also one of the main non communicable diseases in Malaysia that are becoming an economic burden of the nation [30]. By realising the health need of the nation, the Malaysian Ministry of Health adopted the National Strategic Plan for Non-Communicable Disease (NSPNCD) in 2010 [31]. The NSPNCD aimed to achieve health promotion and prevention of NCD by increasing awareness of risk factors and adopting a healthy lifestyle in community based approach.

Our intervention is in line with national strategy and approach for prevention and control of hypertension. Previous studies showed that adherence to the "Dietary Approaches to Stop Hypertension (DASH) diet" alone can reduce both systolic and diastolic blood pressure [7, 18]. Our lifestyle modification incorporates peer support self-blood pressure monitoring and training for home-based exercise to enhance the effect on blood pressure control. Several previous studies conducted in high income countries used either fixed or mobile phone as a method of delivering health coaching either via phone call or short message [10, 3234]. We selected face to face health coaching and exercise training as an appropriate approach since the education status and functional health literacy is low in our study population. Providing an exercise CD and BMI calculator would also motivate and assist our participants to engage in home-based exercise.

We selected a low income urban community as population of interest in order to reduce existing disparities in health status and access to health care across population sub-groups. Previous research conducted in the study area showed that prevalence of hypertension and other cardiovascular risk factors are higher compared to the nation-wide study. The health system in Malaysia is heavily financed by the Government and all citizens can enjoy financial and geographical access to health care [35]. However, there were several undiagnosed cases of hypertension due to lack of awareness of disease symptoms and irregular medical check-up [3]. In addition, poor treatment adherence and non-compliance behaviour challenged effective hypertension control since many people were unaware of the serious complications of hypertension. A previous study conducted in Malaysia showed that more than 95% of patients were unaware that hypertension requires long term treatment [36].

One of the expert recommendations to improve hypertension management in Asia is to increase awareness of hypertension, enhance treatment adherence and promote home blood pressure monitoring [4]. Positive impact of self-monitoring of blood pressure on treatment adherence and reduction of blood pressure has been demonstrated in high income countries [11, 13, 37, 38].

However, to obtain a blood pressure monitor is a big challenge since more than half of our study population have an average household income less than 2,000 MYR which equivalent to (USD 605). The purchase of a reliable quality digital blood pressure monitor would cost about 10% of household income which is generally considered as catastrophic health care expenditure [39]. Our study proposed a solution to overcome the issue of unaffordability to obtain the blood pressure monitor. Since there is an existing social network in the community and practice of sharing resources, we formed a peer support group and provided a digital blood pressure monitor. We believed that it would encourage the sharing of knowledge on hypertension, disease progress and practice of self-blood pressure monitoring among the participants. Although it is expensive for a single person to purchase a blood pressure monitor for his/her own, sharing equipment among peer group members would be affordable and a practical solution for a low income community who lives the same community housing complex.

We expected that after completing intervention, the participants of our study could benefit by increasing awareness of healthy diet and physical activity, adopting healthy life style and improving self-management of hypertension. The proposed intervention would ensure the self-efficacy and self-regulation of regular blood pressure monitoring, healthy diet choice, and maintaining physical activities and exercise with peer social support. There would be a promising possibility that our intervention is widely replicable and adopted as a model of community based approach for combating hypertension in low and middle income countries.


  1. World Health Organization: The global burden of disease: a response to the need for comprehensive, consistent and comparable global information on diseases and injuries. 2007

    Google Scholar 

  2. World Health Organization: Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet. 2010, Canada, WHO.

    Google Scholar 

  3. Ministry of Health Malaysia: The Third National health and Morbidity Survey 2006. 2008, Institute For Public Health, Ministry Of Health Malaysia, II:

    Google Scholar 

  4. Chung N, Baek S, Chen MF, Liau CS, Park C, Park J, Saruta T, Shimamoto K, Wu Z, Zhu J: Expert recommendations on the challenges of hypertension in Asia. Int J Clin Pract. 2008, 62 (9): 1306-1312. 10.1111/j.1742-1241.2008.01838.x.

    Article  CAS  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention: Can Lifestyle Modifications using Therapeutic Lifestyle Changes (TLC) Reduce Weight and the Risk for Chronic Disease?. Research to Practice Series, No 7.

  6. Forman JP, Stampfer MJ, Curhan GC: Diet and lifestyle risk factors associated with incident hypertension in women. JAMA: the journal of the American Medical Association. 2009, 302 (4): 401-411. 10.1001/jama.2009.1060.

    Article  CAS  PubMed  Google Scholar 

  7. Aung DPP: Diet and hypertension. MJCMP. 2005, 9: 37-42.

    Google Scholar 

  8. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB: Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Archives of internal medicine. 2008, 168 (7): 713-10.1001/archinte.168.7.713.

    Article  PubMed  Google Scholar 

  9. Scisney-Matlock M, Bosworth HB, Giger JN, Strickland OL, Van Harrison R, Coverson D, Shah NR, Dennison CR, Dunbar-Jacob JM, Jones L: Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans. Postgrad Med. 2009, 121 (3): 147-10.3810/pgm.2009.05.2015.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bosworth HB, Olsen MK, McCant F, Harrelson M, Gentry P, Rose C, Goldstein MK, Hoffman BB, Powers B, Oddone EZ: Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. Am Heart J. 2007, 153 (6): 918-10.1016/j.ahj.2007.03.004.

    Article  PubMed  Google Scholar 

  11. Bosworth HB, Olsen MK, Grubber JM, Neary AM, Orr MM, Powers BJ, Adams MB, Svetkey LP, Reed SD, Li Y: Two Self-management Interventions to Improve Hypertension ControlA Randomized Trial. Ann Intern Med. 2009, 151 (10): 687-695. 10.7326/0000605-200911170-00148.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS: Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control. JAMA: the journal of the American Medical Association. 2008, 299 (24): 2857-2867. 10.1001/jama.299.24.2857.

    Article  CAS  PubMed  Google Scholar 

  13. Wang V, Smith VA, Bosworth HB, Oddone EZ, Olsen MK, McCant F, Powers BJ, Van Houtven CH: Economic evaluation of telephone self-management interventions for blood pressure control. Am Heart J. 2012

    Google Scholar 

  14. Thomas S, Reading J, Shephard RJ: Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Canadian journal of sport sciences = Journal canadien des sciences du sport. 1992, 17 (4): 338-345.

    CAS  PubMed  Google Scholar 

  15. A Dean, K Sullivan, M Soe: OpenEpi: Open Source Epidemiologic Statistics for Public Health, version 2.3. 1, updated 2011/23/06. 2011

    Google Scholar 

  16. McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, Kaambwa B, Banting M, Bryan S, Little P: Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. The Lancet. 2010, 376 (9736): 163-172. 10.1016/S0140-6736(10)60964-6.

    Article  Google Scholar 

  17. Anderson ES, Winett RA, Wojcik JR: Self-regulation, self-efficacy, outcome expectations, and social support: social cognitive theory and nutrition behavior. Ann Behav Med. 2007, 34 (3): 304-312. 10.1007/BF02874555.

    Article  PubMed  Google Scholar 

  18. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM: Dietary approaches to prevent and treat hypertension a scientific statement from the American Heart Association. Hypertension. 2006, 47 (2): 296-308. 10.1161/01.HYP.0000202568.01167.B6.

    Article  CAS  PubMed  Google Scholar 

  19. 1999 World Health Organization- International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999, 2: 151-183.

  20. World Health Organization(WHO): Developing Integrated Response of health Care Systems to Rapid Population Ageing. 2002, World Health Organization

    Google Scholar 

  21. Bull FC, Maslin TS, Armstrong T: Global physical activity questionnaire (GPAQ): nine country reliability and validity study. Journal of physical activity & health. 2009, 6 (6): 790-

    Google Scholar 

  22. Soo KL, Wan Muda WAM, Wan Nik WS: The Bahasa Melayu Version of the Global Physical Activity Questionnaire: reliability and validity study in malaysia. Asia-Pac J Public He. 2012

    Google Scholar 

  23. Wrieden W, Peace H, Armstrong J, Barton K: A short review of dietary assessment methods used in National and Scottish Research Studies. Briefing Paper Prepared for: Working Group on Monitoring Scottish Dietary Targets Workshop Edinburgh: 2003. 2003

    Google Scholar 

  24. World Health Organization: Waist Circumference and Waist-Hip Ratio Report of a WHO Expert Consultation. Geneva, 8-11 December 2008

  25. Butland R, Pang J, Gross E, Woodcock A, Geddes D: Two-, six-, and 12-minute walking tests in respiratory disease. British medical journal (Clinical research ed). 1982, 284 (6329): 1607-10.1136/bmj.284.6329.1607.

    Article  CAS  Google Scholar 

  26. Du H, Newton PJ, Salamonson Y, Carrieri-Kohlman VL, Davidson PM: A review of the six-minute walk test: its implication as a self-administered assessment tool. Eur J Cardiovasc Nur. 2009, 8 (1): 2-8. 10.1016/j.ejcnurse.2008.07.001.

    Article  Google Scholar 

  27. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB: The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985, 132 (8): 919-

    PubMed Central  CAS  PubMed  Google Scholar 

  28. Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA: A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011, 40 (4): 423-429. 10.1093/ageing/afr051.

    Article  PubMed  Google Scholar 

  29. Trampisch US, Franke J, Jedamzik N, Hinrichs T, Platen P: Optimal Jamar Dynamometer Handle Position to Assess Maximal Isometric Hand Grip Strength in Epidemiological Studies. The Journal of hand surgery. 2012, 37 (11): 2368-2373. 10.1016/j.jhsa.2012.08.014.

    Article  PubMed  Google Scholar 

  30. Al-Efan QMA: Cost of treating hypertension in Malaysia. Asian Journal of Pharmaceutical and Clinical Research. 2009, 2 (1): 1-5.

    Google Scholar 

  31. Ministry of Health Malaysia:National Strategic Plan For Non-Communicable Disease (NSPNCD): Medium Term Strategic Plan To Further Strengthen The Cardiovascular Diseases & Diabetes Prevention & Control Program In Malaysia (2010-2014): Non-Communicable Disease Section, Disease Control Division. 2010, Ministry of Health Malaysia

    Google Scholar 

  32. Brownstein JN, Chowdhury FM, Norris SL, Horsley T, Jack L, Zhang X, Satterfield D: Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007, 32 (5): 435-447. 10.1016/j.amepre.2007.01.011.

    Article  PubMed  Google Scholar 

  33. Park M-J, Kim H-S, Kim K-S: Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension. International journal of medical informatics. 2009, 78 (10): 704-10.1016/j.ijmedinf.2009.06.004.

    Article  PubMed  Google Scholar 

  34. Su TT, Majid H, Amiri MR, Hairi FM, Thangiah N, Bulgiba AM, Murray L: Prevalence of Cardiovascular Disease Risk Factors in a Low Income Urban Community in Kuala Lumpur, Malaysia. International Research Symposium on Population Health 2013 Kualala Lumpur, Malaysia. 2013

    Google Scholar 

  35. Ghani SN, Yadav H: Health care in Malaysia. 2008, University of Malaya Press

    Google Scholar 

  36. Lim T, Ngah B: The Mentakab Hypertension Study project. Part II--Why do hypertensives drop out of treatment?. Singap Med J. 1991, 32 (4): 249-

    CAS  Google Scholar 

  37. Bennett H, Laird K, Margolius D, Ngo V, Thom DH, Bodenheimer T: The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low-income patients: protocol for a randomized controlled trial. Bmc Public Health. 2009, 9 (1): 456-10.1186/1471-2458-9-456.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T: Interventions used to improve control of blood pressure in patients with hypertension. Cochrane database of systematic reviews. 2010, 3 (3):

  39. Krutilova V, Yaya S: Unexpected impact of changes in out-of-pocket payments for health care on Czech household budgets. Health Policy. 2012, 107 (2-3): 276-288. 10.1016/j.healthpol.2012.07.002.

    Article  PubMed  Google Scholar 

Download references


This research was supported by University of Malaya, Flagship project FL009-2011.The authors thank the authority from City Hall Kuala Lumpur, Community Housing Management Committee and participants of the project.

This article has been published as part of BMC Public Health Volume 14 Supplement 3, 2014: Proceedings of the International Research Symposium on Population Health 2013. The full contents of the supplement are available online at Publication charges for this supplement were funded by the University of Malaya.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tin Tin Su.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

TTS, HAM and AMN conceived the study and designed the interventions. AB and LJM gave input on method and statistical analysis. NAA, FMH, NT and MD conducted the pilot testing of the study tools. All authors were responsible for the drafting of this paper and approved the final manuscript.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, T.T., Majid, H.A., Nahar, A.M. et al. The effectiveness of a life style modification and peer support home blood pressure monitoring in control of hypertension: protocol for a cluster randomized controlled trial. BMC Public Health 14 (Suppl 3), S4 (2014).

Download citation

  • Published:

  • DOI: