YPERTENSION IS ONE OF THE leading causes of death worldwide. 1 Almost 1 in 3 US adults has hypertension, defined as a sustained systolic and diastolic blood pressure (BP) of 140 and 90 mm Hg or higher, respectively. 2,3 Lowering BP with antihypertensive medications decreases mortality and major disability from cardiovascular and renal disease. Hypertension, however, remains inadequately treated in the majority of affected individuals. [4][5][6] In recent metaanalyses 7,8 of quality-improvement strategies to lower BP, those targeting patients (education and self-monitoring) or adding a health care team member, such as a nurse or a pharmacist, to focus specifically on hypertension had the largest reductions in BP. Optimal methods for integrating these strategies into routine care were less certain.Electronic medical records (EMRs) and secure patient Web sites increas-See also p 2896 and Patient Page.

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Background Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. Methods 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (n=92) or conventional stretching exercises (n=91) or a self-care book (n=45). Back-related functional status (modified Roland Disability Questionnaire, 23-point scale) and bothersomeness of pain (11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12 and 26 weeks by interviewers unaware of treatment group. Results After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function = −2.5 [95% CI= −3.7 to −1.3; P<0.001]; mean difference for symptoms = −1.1 [95% CI= −1.7 to −0.4; P<0.001]). At 26 weeks, function for the yoga group remained superior (mean difference = −1.8 [95% CI= − 3.1 to −0.5; P<0.0001]). Yoga was not superior to conventional stretching exercises at any time point. Conclusions Yoga classes were more effective than a self-care book, but not stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months.