Disparities in cardiovascular disease, including stroke, remain a major public health problem in the United States. There is an urgent need for secondary prevention strategies that can help to reduce these disparities and the overall burden of stroke. However, progress toward this goal has been hindered by the lack of comparative effectiveness and cost-effectiveness data, particulariy in minority populations, and insufficient utilization of health information technology that is needed to support the dissemination and long-term sustainability of empirically supported interventions. The proposed study will address these critical gaps in the literature by evaluating the comparative effectiveness and cost-effectiveness of a 12-month home blood pressure telemonitoring (HBPTM) intervention versus HBMTM supplemented with individualized, culturally tailored telephone-based nurse case management (NCM) among Black and Hispanic stroke survivors with uncontrolled hypertension. A sample of 450 participants will be recruited from stroke centers and primary care practices at four hospitals in the New York City Health and Hospitals Corporation (HHC) Network, which serves more than 1.3 million urban, diverse patients. Participants will complete study assessments at baseline, 6-months, 12-months and 24-months. The primary outcomes are 12-month change in blood pressure and 24-month stroke recurrence;secondary outcomes are cost-effectiveness at these two time points. The primary hypothesis is that the combined HBPTM+NCM intervention will have greater effects on BP reduction and stroke recurrence and, while it will be more costly, it will also be more cost-effective than HBPTM alone. Possible mechanisms ofthe intervention effects will also be examined, including antihypertensive treatment intensification, health behaviors (diet, physical activity, medication adherence), and other stroke risk factors (diabetes, hyperiipidemia). Major strengths ofthe study include the use of existing health information technology, the evaluation of cost-effectiveness, and a plan to evaluate the sustainability of effects beyond the formal 12-month intervention period. Findings from the proposed study will have important clinical, research and policy implications.

Public Health Relevance

This study will assess the comparative effectiveness, cost-effectiveness, and sustainability of two telemonitoring interventions in reducing blood pressure and recurrent stroke among high-risk Black and Hispanic stroke patients. Results of this study will provide strong empirical evidence to inform clinical guidelines and practice, which may lead to reductions in stroke disparities in the United States.

National Institute of Health (NIH)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZNS1)
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New York University
New York
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Seixas, A; Ravenell, J; Williams, N J et al. (2016) Uncontrolled blood pressure and risk of sleep apnea among blacks: findings from the Metabolic Syndrome Outcome (MetSO) study. J Hum Hypertens 30:149-52
Ortiz, Indira (2016) A Day in the Life of a Home Health Aide/Health Coach. Home Healthc Now 34:340-1
Ojike, Nwakile; Ravenell, Joe; Seixas, Azizi et al. (2016) Racial Disparity in Stroke Awareness in the US: An Analysis of the 2014 National Health Interview Survey. J Neurol Neurophysiol 7:
Jean-Louis, Girardin; Grandner, Michael (2016) Importance of recognizing sleep health disparities and implementing innovative interventions to reduce these disparities. Sleep Med 18:1-2
Ravenell, Joseph; Seixas, Azizi; Rosenthal, Diana Margot et al. (2016) Effect of birthplace on cardiometabolic risk among blacks in the Metabolic Syndrome Outcome Study (MetSO). Diabetol Metab Syndr 8:14
Ojike, Nwakile; Sowers, James R; Seixas, Azizi et al. (2016) Psychological Distress and Hypertension: Results from the National Health Interview Survey for 2004-2013. Cardiorenal Med 6:198-208
Schoenthaler, Antoinette; Luerassi, Leanne; Silver, Stephanie et al. (2016) Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks. Am J Hypertens 29:280-7
Williams, Natasha J; Grandner, Michael A; Wallace, Douglas M et al. (2016) Social and behavioral predictors of insufficient sleep among African Americans and Caucasians. Sleep Med 18:103-7
Jean-Pierre, Pascal; Grandner, Michael A; Garland, Sheila N et al. (2015) Self-reported memory problems in adult-onset cancer survivors: effects of cardiovascular disease and insomnia. Sleep Med 16:845-9
Williams, Natasha J; Nunes, João V; Zizi, Ferdinand et al. (2015) Factors associated with referrals for obstructive sleep apnea evaluation among community physicians. J Clin Sleep Med 11:23-6

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