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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZHL1-CSR-B (S1))
Program Officer
Einhorn, Paula
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New York University
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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