Document Detail


Racial differences in the effect of a telephone-delivered hypertension disease management program.
MedLine Citation:
PMID:  22865016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events.
OBJECTIVE: The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program.
PARTICIPANTS: Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial.
INTERVENTIONS: Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values.
MAIN MEASURES: Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure).
KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p=0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p=0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p=0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients.
CONCLUSIONS: The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.
Authors:
George L Jackson; Eugene Z Oddone; Maren K Olsen; Benjamin J Powers; Janet M Grubber; Felicia McCant; Hayden B Bosworth
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-08-03
Journal Detail:
Title:  Journal of general internal medicine     Volume:  27     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-29     Completed Date:  2013-06-04     Revised Date:  2013-12-05    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1682-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
African Americans / statistics & numerical data
Aged
Antihypertensive Agents / administration & dosage
Behavior Therapy / organization & administration*
Blood Pressure Determination
Confidence Intervals
Disease Management
European Continental Ancestry Group / statistics & numerical data
Female
Humans
Hypertension / diagnosis,  ethnology*,  therapy*
Intervention Studies
Male
Medication Therapy Management / organization & administration*
Middle Aged
North Carolina
Program Evaluation
Risk Assessment
Severity of Illness Index
Telecommunications
Telemedicine / organization & administration*
Telephone
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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