Uncontrolled hypertension is a major health problem among African Americans residing in inner cities. The proposed project is a community based education program which will use existing resources to improve hypertension control in the inner city through multiple interventions. The program consists of a community wide education program, an intensive intervention directed toward individuals with hypertension, and an intervention for health care providers. The program will be developed by a coalition of community organizations. In the community wide educational intervention, a baseline household survey will be used to identify barriers to hypertension control in the community. This information will be used in planning the intervention strategies, targeting the educational efforts, and developing the educational messages. We will utilize existing community organizations (churches, local media, neighborhood organizations, etc) to implement educational efforts over a three year period. Program success will be evaluated by comparing findings on a follow-up household survey with those at baseline. Level of blood pressure control will be the primary outcome measure. For the intensive educational program for hypertensives, we will develop a hypertension registry of individuals with high blood pressure who are identified from a number of community sources. All individuals on the registry will receive educational material through the mail. Individuals with uncontrolled hypertension will be randomized to receive the usual mailed educational materials or a more intensive personalized 12 month intervention using lay health advisors. In the evaluation, we will compare blood pressure control morbidity and mortality between these two intervention arms of the registry. Our innovative educational approach to health care providers will utilize the existing community-based Area Health Education Center (AHEC) network to communicate community-determined hypertension control needs and community-determined hypertension control strategies to health care providers and students. Our research is designed to elucidate community factors in the inner city that dictate strategies necessary for success in a variety inner city environments. Specifically we will look at the effect of community size and level of community stress (as indicated by poverty, crime, etc.) on program development and outcome. To do this, we will implement the program in one city-wide community (Milwaukee) and in three well defined, homogeneous inner city neighborhoods of Chicago which have differing levels of community stress indicators. We will evaluate the effect of size and community stress levels on the program strategies and successes.
