The primary objective of the proposed trial is to compare the differential reduction in blood pressures (BP) in 310 inner city underserved hypertensive African-American men 18-49 years old; the age- sex-race subgroup with HBP that continues to be most poorly diagnosed, treated, controlled and studied and disproportionally suffers from premature HBP related morbidity and mortality. The study is designed to test the effectiveness of a comprehensive, educational-behavioral and treatment HBP control program, provided by a nurse practitioner (NP) community health worker (CHW)-physician (MD) team compared to usual medical care available in the East Baltimore community. In this clinical trial, the NP-CHW-MD intervention program will address barriers to care and treatment and social support, as well as health care skills and use of health care and human service resources, with the goal of increasing entry into care, retention in care, and adherence to therapy. Participants in both groups will be evaluated at baseline and at 12 and 24 months by trained staff in the Johns Hopkins Outpatient General Clinic Research Center who are blinded to group assignment. This study builds on the principal investigator's 1992-95 K08 Clinician Investigator Award which demonstrated the feasibility of identifying, recruiting and tracking 204 African-American hypertensive men ages 18-49 living in East Baltimore and measuring psychosocial and behavioral factors, and BP. This model also builds on the investigators' 20 years of experience in HBP care and control in this community. In addition, this model offers culturally sensitive and relevant provision of advanced practice nursing care, and includes an enhanced CHW outreach approach which the men in the ongoing studies clearly feel is responsive to their unique needs.
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