African Americans (AA) have the highest prevalence of hypertension (HTN) in the US, with a resultant greater HTN-related mortality compared to whites. Barriers to BP control in AA exist at 3 levels of care: the patient, the physician and the healthcare system. Using the Chronic Care Model as a framework, we sought to test the effect on BP control, of a multicomponent, multi-level intervention targeted at physicians and patients. We will conduct a clustered randomized controlled trial in which 30 Community/Migrant Health Centers (C/MHCs) will be randomized to either the intervention or usual care. A total of 990 patients with uncontrolled HTN (BP>140/90 mm hg) will be enrolled for this trial. Components of the patient intervention includes an innovative patient education approach known as Self-Paced Programmed Instruction that will be used to educate patients on knowledge of HTN;Behavioral Counseling by trained C/MHC dieticians on lifestyle modification;and Home BP Monitoring to activate patients in their own care. The physician intervention comprises Online CME courses on management of HTN based on JNC-7 guidelines;Online HTN Rounds/Case Conferences with HTN Specialists;and Feedback to physicians on clinical performance measures via computerized decision support systems. The intervention will be delivered to patients every 3 months during regular office visits for 12 months, while the physician intervention will occur every month for the duration of the trial. Patients and physicians at the usual care C/MHCs will receive NHLBI patient education materials and print versions of JNC-7 guidelines respectively. The primary outcome is the proportion of patients with adequate BP control at 12 months in each condition as defined by JNC-7 criteria (BP<130/80 mmhg for patients with diabetes or kidney disease;and BP <140/90 mmhg for all other patients). The secondary outcomes are within-patient change in SBP and DBP from baseline to 12 months;the maintenance of the intervention effects one year after trial;and the cost effectiveness of the intervention at 12 months. The long-term goal of this project is to refine the intervention as a result of the data obtained and to develop a standardized protocol that can be integrated into the usual care procedures of the C/MHCs. Thus, maximizing the likelihood that the intervention will be translated into practice, at each of the participating Community Health Center.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
3R01HL078566-05S1
Application #
7864568
Study Section
Special Emphasis Panel (ZHL1-CSR-B (S1))
Program Officer
Einhorn, Paula
Project Start
2004-09-30
Project End
2011-11-30
Budget Start
2008-07-01
Budget End
2011-11-30
Support Year
5
Fiscal Year
2011
Total Cost
$258,449
Indirect Cost
Name
New York University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
121911077
City
New York
State
NY
Country
United States
Zip Code
10016
Schoenthaler, Antoinette M; Butler, Mark; Chaplin, William et al. (2016) Predictors of Changes in Medication Adherence in Blacks with Hypertension: Moving Beyond Cross-Sectional Data. Ann Behav Med :
Pavlik, Valory N; Chan, Wenyaw; Hyman, David J et al. (2015) Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials. Curr Hypertens Rev 11:123-31
Ogedegbe, Gbenga; Tobin, Jonathan N; Fernandez, Senaida et al. (2014) Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects. Circulation 129:2044-51
Iftikhar, Imran H; Kline, Christopher E; Youngstedt, Shawn D (2014) Effects of exercise training on sleep apnea: a meta-analysis. Lung 192:175-84
Ogedegbe, Gbenga; Fernandez, Senaida; Fournier, Leanne et al. (2013) The Counseling Older Adults to Control Hypertension (COACH) trial: design and methodology of a group-based lifestyle intervention for hypertensive minority older adults. Contemp Clin Trials 35:70-9
Williams, Stephen K; Fiscella, Kevin; Winters, Paul et al. (2013) Association of racial disparities in the prevalence of insulin resistance with racial disparities in vitamin D levels: National Health and Nutrition Examination Survey (2001-2006). Nutr Res 33:266-71
Donat, Margaret; Brown, Clinton; Williams, Natasha et al. (2013) Linking sleep duration and obesity among black and white US adults. Clin Pract (Lond) 10:
Williams, N; Abo Al Haija, O; Workneh, A et al. (2013) Excessive Daytime Sleepiness among Hypertensive US-Born Blacks and Foreign-Born Blacks: Analysis of the CAATCH Data. Int J Hypertens 2013:852389
Schoenthaler, Antoinette; Allegrante, John P; Chaplin, William et al. (2012) The effect of patient-provider communication on medication adherence in hypertensive black patients: does race concordance matter? Ann Behav Med 43:372-82
Rideaux, Tiffany; Beaudreau, Sherry A; Fernandez, Senaida et al. (2012) Utility of the abbreviated Fuld Object Memory Evaluation and MMSE for detection of dementia and cognitive impairment not dementia in diverse ethnic groups. J Alzheimers Dis 31:371-86

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