Uncontrolled hypertension leads to excessive rates of cardiac, cardio-vascular and peripheral vascular disease, and renal failure. Adequate control of hypertension reduces the incidence of cardiovascular and renal injuries. However, even though effective hypertensive treatments are available, 75% of individuals with hypertension are not adequately controlled: of these, a substantial number are in some kind of treatment but are not under control. Moreover, almost 70% of hypertensive patients are not even being treated. A measure contributing to therapeutic failure is non-compliance, which can be improved by positive social support from family, friends, or health-care providers. The candidate has recently established a church-based Wellness Ministry in the inner city of St. Louis, Missouri. Of 24 adults that were screened in the church, 71% were hypertensive. This number appears to be consistent with the prevalence of hypertension in African-Americans living in an urban setting. The candidate proposes to test the hypothesis that a church member with hypertension will be more likely to comply with therapeutic requests from the provider when receiving concomitant support from a patient-designated fellow church member. The investigators will use two neutral educational interventions in the population: support provided by a family member or a patient-designated church member. The investigators will then determine whether the support provided by the designated church member is directive or not directive and the extent by which it is conducive to positive outcomes regarding compliance, continuity of care, and blood pressure control. NOTE: The comments below were prepared by the reviewers assigned to this application. They are provided to illustrate the opinions expressed. The application was discussed and scored by all reviewers present, although any committee member in conflict was absent during the discussion and scoring. The attached commentaries do not necessarily reflect the position of the authors at the close of the group discussion nor the final majority opinion of the group, although reviewers were asked to amend their commentaries if their positions changed during the discussion of an application. The resume and other initial sections of the summary statement are the authoritative representation of the final outcome of group discussion. If there is any discrepancy between the peer reviewers' commentaries and the numerical score on the face page of this summary statement, the numerical score should be considered the most accurate representation of the final outcome of the group discussion.
