A three-year Johns Hopkins study led by a nurse investigator has found that it may take a “village” to significantly lower the blood pressure of urban African-American men. “The traditional one-on-one doctor-patient visit in a doctor’s office will simply not work,” says lead author Martha N. Hill, Ph.D., R.N., dean of The Johns Hopkins University School of Nursing. “What our study suggests is that you need a whole team socially and culturally linked to this population, including community members as staff and a vigorous tracing method to assure compliance with the blood pressure reducing regimen.”
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.
While men in both groups benefited from the intervention, men who received the intensive intervention had blood pressure control rates of 44 percent compared to a 17 percent control rate at the start of the study. Among the men receiving only education and referrals, blood pressure control rates increased from 21 percent to 31 percent. The overall control rate for hypertensive people nationwide is 27 percent.
Upon completion of the research, Hill’s team worked with The Men’s Center, a clinic in East Baltimore, to make sure the men in the study continue to have access to receiving treatment to control their blood pressure.
The study was supported by the National Institute of Nursing Research and the National Center for Research Resources, both of the National Institutes of Health, Department of Health and Human Services; W.A. Baum Co. Inc.; and Merck & Co. Inc. Other authors include Cheryl R. Dennison, Ph.D., R.N., Hae-Ra Han, Ph.D., R.N., Miyong Kim, Ph.D., R.N., and Mary C. Roary, M.H.S., all from the School of Nursing; Roger S. Blumenthal, M.D., David M. Levine, M.D., Sc.D., and Wendy S. Post, M.D., M.S., all from the School of Medicine; and Lee R. Bone, R.N., M.P.H., from the Bloomberg School of Public Health.