Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 May 20;129(20):2044-51.
doi: 10.1161/CIRCULATIONAHA.113.006650. Epub 2014 Mar 21.

Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects

Gbenga Ogedegbe  1 , Jonathan N Tobin  2 , Senaida Fernandez  2 , Andrea Cassells  2 , Marleny Diaz-Gloster  2 , Chamanara Khalida  2 , Thomas Pickering  2 , Joseph E Schwartz  2
Affiliations
Randomized Controlled Trial

Counseling African Americans to Control Hypertension: cluster-randomized clinical trial main effects

Gbenga Ogedegbe et al. Circulation. .

Abstract

Background: Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices.

Methods and results: Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]).

Conclusions: A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00233220.

Keywords: blacks; clinical trial; health behavior; healthcare disparities; hypertension.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

Figure 1
Figure 1
Consort Diagram for CAATCH Trial.
Figure 2
Figure 2
Blood Pressure Control Rates at 12 Months By CHC (based on BpTRU).
Figure 3
Figure 3
A. Within-patient change in BpTRU Systolic BP from Baseline to 12 Months. B. Within-patient change in BpTRU Diastolic BP from Baseline to 12 Months.
Figure 3
Figure 3
A. Within-patient change in BpTRU Systolic BP from Baseline to 12 Months. B. Within-patient change in BpTRU Diastolic BP from Baseline to 12 Months.
Figure 4
Figure 4
Forrest Plot of Subgroup Analysis: Odds Ratio for BP Control in IC versus UC Sites.
See this image and copyright information in PMC

Comment in

References

    1. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–2050. - PubMed
    1. Wong ND, Lopez VA, L’Italien G, Chen R, Kline SE, Franklin SS. Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med. 2007;167:2431–2436. - PubMed
    1. Ogedegbe G. Barriers to optimal hypertension control. J Clin Hypertens (Greenwich) 2008;10:644–646. - PMC - PubMed
    1. Fahey T, Schroeder K, Ebrahim S. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2006:CD005182. - PubMed
    1. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010:CD005182. - PubMed

Publication types

Substances

Associated data