Objectives: African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP. Three of the groups performed a pooled analysis of trial results to determine: 1) the magnitude of the combined intervention effect; and 2) how the pooled results could inform the methodology for future health-system level BP interventions.
Methods: Using a cluster randomized design, the trials enrolled AAs with uncontrolled hypertension to test interventions targeting a combination of patient and clinician behaviors. The 12-month Systolic BP (SBP) and Diastolic BP (DBP) effects of intervention or control cluster assignment were assessed using mixed effects longitudinal regression modeling.
Results: 2,015 patients representing 352 clusters participated across the three trials. Pooled BP slopes followed a quadratic pattern, with an initial decline, followed by a rise toward baseline, and did not differ significantly between intervention and control clusters: SBP linear coefficient = -2.60±0.21 mmHg per month, p<0.001; quadratic coefficient = 0.167± 0.02 mmHg/month, p<0.001; group by time interaction group by time group x linear time coefficient=0.145 ± 0.293, p=0.622; group x quadratic time coefficient= -0.017 ± 0.026, p=0.525). Results were similar for DBP. The individual sites did not have significant intervention effects when analyzed separately.
Conclusion: Investigators planning behavioral trials to improve BP control in health systems serving AAs should plan for small effect sizes and employ a “run-in” period in which BP can be expected to improve in both experimental and control clusters.
Keywords: African-Americans, hypertension control, cluster randomized trial, effect size, health disparities, health systems interventions, high blood pressure, minority health, practice-based research network (PBRNs).
Cardiovascular Control After Spinal Cord Injury
Current Vascular Pharmacology Neuroinflammatory Markers in Spontaneously Hypertensive Rat Brain: An Immunohistochemical Study
CNS & Neurological Disorders - Drug Targets Modulation of Renin-Angiotensin System and Arterial Stiffness: Evidence from Clinical Trials
Current Hypertension Reviews The Cardiologist in the Periphery: Indications and Usefulness of Peripheral Artery Invasive Angiography in Patients Undergoing Coronary Angiography
Current Medical Imaging Therapeutic Perspectives in Systemic Lupus Erythematosus
Current Rheumatology Reviews Static Cerebral Blood Flow Autoregulation in Humans
Current Hypertension Reviews The Promises and Challenges of the Use of Genomics in the Prescription of Exercise for Hypertension: The 2013 Update
Current Hypertension Reviews Endothelial Dysfunction in the Hypertensive State: Mechanisms of Hypertensive Cardiovascular Complications
Current Hypertension Reviews Diagnosis of Surgically-Treatable Forms of Primary Aldosteronism
Current Hypertension Reviews Evaluation of Clinical Efficacy of Fasudil for the Treatment of Pulmonary Arterial Hypertension
Recent Patents on Cardiovascular Drug Discovery (Discontinued) The Purinome, a Complex Mix of Drug and Toxicity Targets
Current Topics in Medicinal Chemistry Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?
Current Cardiology Reviews Treatment of Hypertensive Left Ventricular Hypertrophy
Current Pharmaceutical Design Interactions Between the Sympathetic Nervous System and Angiotensin System in Renovascular Hypertension
Current Hypertension Reviews Maternal Nutrition and Predisposition to Later Kidney Disease
Current Drug Targets Targeting Small Arteries of Hypertensive Status with Novel ATP-Sensitive Potassium Channel Openers&#
Current Vascular Pharmacology Cardioprotective effects of Aronia melanocarpa anthocynanins. From laboratory experiments to clinical practice.
Current Pharmaceutical Design Nanoparticle Based Treatment for Cardiovascular Diseases
Cardiovascular & Hematological Disorders-Drug Targets Correlation between Decreased Parasympathetic Activity and Reduced Cerebrovascular Reactivity in Patients with Lacunar Infarct
Current Neurovascular Research The Role of Renal Nerve Ablation for the Management of Resistant Hypertension and other Disease Conditions: Benefits and Concerns
Current Vascular Pharmacology