To the Editor: In the United States, hypertension control rates in elderly patients continue to lag behind those of their younger counterparts despite the increasing evidence demonstrating the benefit of lowering blood pressure.1 This disparity by age has increased over the last 2 decades, from 9% in the early 1990s to more than 14% in 2000.1 Despite guidelines and evidence for the role of lifestyle counseling in hypertension management, many elderly patients are not receiving counseling2 and are not following healthy behaviors.3-5 Our objective was to develop a multidisciplinary hypertension management program (the Lifestyle University) in a geriatric primary care setting and assess its effectiveness in lowering blood pressure and improving healthy behaviors, psychosocial well-being, and quality of life. This was a longitudinal nonrandomized prospective study of patients aged 55 and older with hypertension (blood pressure≥140/90 mmHg or receiving antihypertensives) in the southeastern United States. Recruitment was performed during blood pressure screening activities at various community events, health fairs, faith-based establishments, and barbershops. Change in blood pressure of participants was compared with that of a matched historical sample of patients with hypertension who were followed at the primary care practice but were not enrolled in the program. The intervention was a 6-month multidisciplinary lifestyle and disease education program (6 sessions, 2.0–2.5 hours each). The areas targeted were disease knowledge, dietary changes to match the Dietary Approaches to Stop Hypertension-sodium diet,6 physical activity, weight loss if indicated, stress management, patient physician interaction, and patient adherence. Data on the participants were collected before start of intervention (baseline), after completing the intervention (12 weeks), and at 6 months. Data collected included blood pressure, body mass index, medication inventory, hypertension disease knowledge, perceived stress levels, dietary and physical activity assessments, adherence, patient–physician interaction, and overall social support and quality-of-life measures. Trend analysis was performed using mixed models in both groups. Of those screened, 50 agreed to participate in this study, and six did not. Mean age±standard error of those who agreed was 70.6±1.2, 80% were women, 26% were African American, blood pressure was 144.6/77.2±2.7/1.7 mmHg at baseline, 43 completed the 3-month assessment, and 36 completed the 6-month assessments. There was no difference on any measure between those who completed and those who did not complete the three evaluations. Fifty-five historical controls (aged 73.1±0.7, 80% women, 16% African American, blood pressure 152.1/77.4±2.91.8 mmHg) who were not enrolled in the current program from the primary care practice database were matched. Patients enrolled in the program demonstrated a decline in systolic blood pressure of 11.8±2.8 mmHg (P<.001) versus 7.9±2.5 mmHg (P=.002) in the historical control group. There was no change in diastolic blood pressure in either group. At baseline, 44% of the participants in the intervention group were controlled to below 140/90 mmHg. This rate improved to 63% at 3 months and 74% at 6 months (P<.001 for trend). These rates improved despite no change in the number of antihypertensive subjects between baseline and 6 months (2.0±0.9 antihypertensive medications at baseline vs 2.1±0.9 at 6 months, P=.28). In the historical control group, there was no significant improvement in the rate of controlled hypertension (19% at baseline vs 31% at the second and 31% at the third measurement point, P=.09 for the trend). The following measures showed significant improvement: physical activity, dietary consumption of fruits and vegetables, stages of change for diet and physical activity, perceived stress, hypertension beliefs, adherence to medical advice, and interaction with the physician. Quality-of-life and social support measures also showed an improvement (Table 1). This study suggests that a program provided at the point of delivery of primary care to translate national guidelines and research findings about hypertension management into clinical practice may improve hypertension control and healthy behavior in older patients. This program may improve quality of life without increasing pharmacotherapy. This study is in accordance with prior studies,7, 8 but it shows that incorporating such a program in the primary care setting is successful and effective. Contrary to the suspicion that elderly patients may not follow a behavioral change program, this study suggests that such change is possible and is associated with improved quality of life. Although the changes in the individual lifestyle measures were small, the overall control rate improved. This suggests that small changes in lifestyle behaviors and disease education may improve blood pressure control. Therefore, a multidisciplinary program, incorporated into primary care, maybe effective in improving hypertension control and healthy behaviors without increasing pharmacotherapy in elderly patients. The authors, Ihab Hajjar, Brandy Dickson, Jennifer Blackledge, Paige Lewis, Ken Watkins all state that they have received no financial support for research, consultantships, and speakers forum, as well as having any company holdings (e.g., stocks) or patents. Financial Disclosure: This study was supported by a generous grant from the Duke Foundation. Author Contributions: Study Concept and Design: Hajjar, Dickson, Watkins, and Blackledge. Acquisition of Subjects and/or Data: Dickson and Blackledge. Analysis and Interpretation of Data: Lewis, Hajjar, Dickson, Watkins, and Blackledge. Preparation of manuscript: Lewis, Hajjar, Dickson, Watkins, and Blackledge. Sponsor's Role: Provide cost for conducting the study and salary support for the research team.