Racial Differences in Two Self-Management Hypertension Interventions - 19/08/11
, Maren K. Olsen, PhD a, d, Janet M. Grubber, MSPH a, b, Benjamin J. Powers, MD a, b, Eugene Z. Oddone, MD, MHS a, b
Requests for reprints should be addressed to Hayden B. Bosworth, PhD, Center for Health Services Research in Primary Care, Duke University, 2424 Erwin Road, Hock Plaza, Durham, NC 27703Abstract |
Background |
Only one half of Americans have their blood pressure controlled, and there are significant racial differences in blood pressure control. The goal of this study was to examine the effectiveness of 2 patient-directed interventions designed to improve blood pressure control within white and non-white subgroups (African Americans, 49%).
Methods |
Post hoc analysis of a 2 by 2 randomized trial with 2-year follow-up in 2 university-affiliated primary care clinics was performed. Within white and non-white patients (n=634), 4 groups were examined: 1) usual care; 2) home blood pressure monitoring (3 times per week); 3) tailored behavioral self-management intervention administered via telephone by a nurse every other month; and 4) a combination of the 2 interventions.
Results |
The overall race by time by treatment group effect suggested differential intervention effects on blood pressure over time for whites and non-whites (systolic blood pressure, P=. 08; diastolic blood pressure, P=.01). Estimated trajectories indicated that among the 308 whites, there was no significant effect on blood pressure at 12 or 24 months for any intervention compared with the control group. At 12 months, the non-whites (n=328) in all 3 intervention groups had systolic blood pressure decreases of 5.3 to 5.7 mm Hg compared with usual care (P <.05). At 24 months, in the combined intervention, non-whites had sustained lower systolic blood pressure compared with usual care (7.5 mm Hg; P <.02). A similar pattern was observed for diastolic blood pressure.
Conclusion |
Combined home blood pressure monitoring and a tailored behavioral phone intervention seem to be particularly effective for improving blood pressure in non-white patients.
Le texte complet de cet article est disponible en PDF.Keywords : Adherence, Clinical Trial, Disparities, Hypertension, Lifestyle, Self-management
Plan
| Funding: This research is supported by National Heart, Lung, and Blood Institute Grant R01 HL070713 and an Established Investigator Award from the American Heart Association to HBB. HBB also received a Pfizer Foundation Health Communication Initiative award, which allowed for increasing the enrollment of individuals with low literacy. |
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| HBB was also supported by a career scientist award (RCS 08-027) and BJP was supported by a career development award (CDA 09-218) both from the Veterans Affairs, Health Services Research and Development. |
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| Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. No other individuals assisted in manuscript preparation. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Trial Registration: ClinicalTrials.gov; Registration Number: NCT00123058; Registry URL: www.clinicaltrials.gov. |
Vol 124 - N° 5
P. null - mai 2011 Retour au numéro
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