The primary objective of the proposed clinical trial is to investigate whether educational-behavioral interventions, administered by a nurse- community health worker (CHW) team, reduce high blood pressure (HBP), and increase retention in care and adherence to therapy, in inner city hypertensive African American men, 18-49 years of age; the age-sex-race group with HBP that remains the least well diagnosed, treated, and controlled. Participants will be recruited from the Emergency Department, their usual source of primary health care. All, regardless of group assignment, will be referred to, and/or encouraged to remain in, medical care for BP control. The study is designed as a randomized clinical trial to test the effectiveness of a nurse-CHW intervention program compared to usual medical care. The nursing multicomponent intervention program addresses perceived psychological barriers to treatment (measured by scales developed and piloted by the investigator), social support, and use of health care resources. The interventions are: 1. counseling sessions with the nurse and CHW to increase understanding of, and commitment and adherence to, the prescribed regimen; 2. telephone follow-up to address concerns of the participant; and 3. a home visit with the family member/friend, identified by the participant as the primary source of social support regarding the regimen, to enhance the contribution of this individual to the participant's commitment and adherence. Two hundred men who meet eligibility criteria will be randomized to the special intervention (SI) group or the usual care (UC) group and followed for 12 months. The major outcomes are BP reduction, retention in care, and adherence to therapy. Statistical analysis will focus on differences in mean reduction in BP between groups and the proportion in each group who remain in care and adhere to treatment recommendations. Multiple regression will be done to determine the predictors of BP reduction, increased retention in care and adherence to therapy, and changes in perceived psychological barriers, social support, and social support. This study is significant because the nurse, practicing with a minority CHW from the target community, offers a culturally appropriate approach to closing the health gap for African American males by maximizing BP control. There are no reported investigations of creative strategies to reduce HBP in the high risk target group. The proposal builds on extensive prior work, it investigates effective nursing interventions in a randomized trial, and the resources are plentiful and superior. Conduct of this study, and directed research related training activities, will provide the principal investigator with the opportunity to address a major public health problem in a fully mentored concentrated research program. This experience will accelerate the investigator's transition to an independent investigator and mentor of doctoral students.
| Hill, M N; Bone, L R; Hilton, S C et al. (1999) A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes. Am J Hypertens 12:548-54 |
