The purpose of this demonstration project is to develop, implement and assess methods to improve the control of blood pressure (BP). The two proposed studies will determine the medical and cost effectiveness of specific interventions designed to improve BP control in defined but representative general communities. Previous work in this Center has demonstrated that systematic approaches to the provision of antihypertensive care produce results more satisfactory than can routinely be obtained through conventional approaches. It has also been shown that the provision of antihypertensive care within the context of a socially cohesive environment encourages long-term adherence to treatment. The present proposal builds on this experience. Specific strategies to improve blood pressure control will be tested in two settings. In Project 1, in collaboration with the Johnson and Johnson corporation, a prospective controlled trial will be established among 5,000 employees in 4 worksite models. Within these 4 models it will be possible to test singly and in combination the impact of occupationally based follow-up and on-site nurse monitoring on blood pressure control. Project 2 will assess the impact of cost and accessibility to antihypertensive drugs on blood pressure control in elderly hypertensive patients. In collaboration with the Department of Aging of the City of New York, 4 Senior Citizen Centers will be selected to provide the following: 1) free drugs at the center, 2) free drugs at neighborhood pharmacies, 3) drugs purchased at the center, and 4) drugs purchased at neighborhood pharmacies. Analysis will indicate whether the cost and/or accessibility of drugs are impediments to the attainment of blood pressure control. These projects should provide data that will encourage replication of efficient and effective strategies to enhance BP control in the community.
