The primary objective of this four-year proposal is to develop effective strategies for enhancing adherence to therapeutic interventions designed to improve care for hypertensive minority populations. An aggressive Hypertension Intervention Project (HIP) will be developed in the Hypertension Research Section of King/Drew Medical Center in South- Central Los Angeles. The private CHUER clinic (located in the same cachement area) will subcontract with the Drew University Center in a community coalition consisting of several large health advocacy organizations. The applicant proposes to enroll over 1 ,800 new and existing hypertensive subjects. Over three-quarters of the patients will be African-Americans, with the remaining 25 percent Hispanic, reflecting the demographics of our cachement area. All 1800 subjects will be randomized into usual care (controls) or interventional care (experimental) at the initiation of the HIP. The cornerstone of our aggressive intervention will be the development of a computerized patient tracking system and the introduction into clinic of several educational activities including a) exit interviews; b) home visits; c) support group sessions, and d) community health seminars/fairs. Community Health Workers will perform the bulk of the patient tracking and educational intervention field work. Outcome measures of pre and post-study blood pressure, renal function, body weight change, and all-cause mortality will be compared between experimental and controls at two, three and four years into the study. Quality-of-life questionnaires will be obtained pre and post-study and analyzed for new insights into needs assessment, awareness of hypertension, attitudes towards treatment, compliance with drug therapy, and effectiveness of various educational interventions employed in the study. Concurrent efforts to reduce co-morbid risk factors such as obesity, cigarette smoking, excessive alcohol consumption and stress will be assessed as secondary outcomes. The HIP will hope to demonstrate cost-effective innovations for the adaptation of these Medical Center-targeted strategies to community physicians and health clinics of the inner city.
