Counseling african americans to control hypertension: Cluster-randomized clinical trial main effects

Gbenga Ogedegbe, Jonathan N. Tobin, Senaida Fernandez, Andrea Cassells, Marleny Diaz-Gloster, Chamanara Khalida, Thomas Pickering, Joseph E. Schwartz

Research output: Contribution to journalArticle

Abstract

BACKGROUND - : Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices. METHODS AND RESULTS - : Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]). CONCLUSIONS - : A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population.

Original languageEnglish (US)
Pages (from-to)2044-2051
Number of pages8
JournalCirculation
Volume129
Issue number20
DOIs
StatePublished - May 20 2014

Fingerprint

African Americans
Counseling
Randomized Controlled Trials
Blood Pressure
Hypertension
Community Health Centers
Odds Ratio
Patient Education
Confidence Intervals
Diabetes Mellitus
Physicians
Ambulatory Blood Pressure Monitoring
Life Style
Reading
Primary Health Care
Guidelines
Equipment and Supplies
Population

Keywords

  • blacks
  • clinical trial
  • health behavior
  • healthcare disparities
  • hypertension

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Ogedegbe, G., Tobin, J. N., Fernandez, S., Cassells, A., Diaz-Gloster, M., Khalida, C., ... Schwartz, J. E. (2014). Counseling african americans to control hypertension: Cluster-randomized clinical trial main effects. Circulation, 129(20), 2044-2051. https://doi.org/10.1161/CIRCULATIONAHA.113.006650

Counseling african americans to control hypertension : Cluster-randomized clinical trial main effects. / Ogedegbe, Gbenga; Tobin, Jonathan N.; Fernandez, Senaida; Cassells, Andrea; Diaz-Gloster, Marleny; Khalida, Chamanara; Pickering, Thomas; Schwartz, Joseph E.

In: Circulation, Vol. 129, No. 20, 20.05.2014, p. 2044-2051.

Research output: Contribution to journalArticle

Ogedegbe, G, Tobin, JN, Fernandez, S, Cassells, A, Diaz-Gloster, M, Khalida, C, Pickering, T & Schwartz, JE 2014, 'Counseling african americans to control hypertension: Cluster-randomized clinical trial main effects', Circulation, vol. 129, no. 20, pp. 2044-2051. https://doi.org/10.1161/CIRCULATIONAHA.113.006650
Ogedegbe, Gbenga ; Tobin, Jonathan N. ; Fernandez, Senaida ; Cassells, Andrea ; Diaz-Gloster, Marleny ; Khalida, Chamanara ; Pickering, Thomas ; Schwartz, Joseph E. / Counseling african americans to control hypertension : Cluster-randomized clinical trial main effects. In: Circulation. 2014 ; Vol. 129, No. 20. pp. 2044-2051.
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abstract = "BACKGROUND - : Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices. METHODS AND RESULTS - : Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28{\%} men, 59{\%} obese, and 36{\%} with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3{\%} versus UC=44.5{\%}; odds ratio, 1.21 [95{\%} confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0{\%} versus UC=44.7{\%}; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1{\%} versus UC=39.6{\%}; odds ratio, 1.45 [confidence interval, 1.04-2.45]). CONCLUSIONS - : A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population.",
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