Team Approach Works Better To Reduce Blood Pressure in African-American Men

While further research is needed to demonstrate the cost effectiveness of intense team intervention, Hill says, she suspects it will be a savvy investment. “These men tend to use a hospital emergency room for primary care,” she says, “so spending the relatively low costs for intervention now should help keep these men healthier and out of expensive hospital care later.”

Results of the study of 309 hypertensive African-American men ages 21 to 54 living in inner-city Baltimore, published in the November issue of the American Journal of Hypertension, also dispel the myth that underserved African-American men are hard to include in clinical trials, says Hill. “This high-risk population is vastly under-studied and typically thought to be hard to reach,” says Hill, “but we found that the men cared about their health and were eager to manage their high blood pressure and to participate in the research.”

High blood pressure affects one in four American adults. Among African Americans, it occurs more often, begins at an earlier age, and is usually more severe compared to whites. In addition, organ damage resulting from hypertension is higher among African Americans. In poor, urban communities, social and economic burdens often contribute to lower rates of treatment and control.

Hill and colleagues from The Johns Hopkins University School of Nursing, School of Medicine, and Bloomberg School of Public Health set out to evaluate the effectiveness of a multidisciplinary team intervention program that included education, behavior modification, and free hypertension medication to control blood pressure. The team comprised a nurse practitioner, community health workers, and a physician.

Participants were randomly assigned to one of two groups.  Both groups were given education about the benefits of controlling hypertension. One group then received a comprehensive, individualized intervention by the health care team. Nurse practitioner visits were scheduled every one to three months and all participants got free high blood pressure medication. A community health worker provided referrals to social services, including job training, and assisted with locating housing. The men in the other group received a less intensive intervention including referrals to sources of hypertension care in the community. Men in both groups received reminders of the importance of blood pressure control and were evaluated at the beginning of the intervention and at 12-, 24-, and 36-month intervals.