|Racial differences in the effect of a telephone-delivered hypertension disease management program.|
|PMID: 22865016 Owner: NLM Status: MEDLINE|
|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.
|George L Jackson; Eugene Z Oddone; Maren K Olsen; Benjamin J Powers; Janet M Grubber; Felicia McCant; Hayden B Bosworth|
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|Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S. Date: 2012-08-03|
|Title: Journal of general internal medicine Volume: 27 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2012 Dec|
|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|
|Languages: eng Pagination: 1682-9 Citation Subset: IM|
|APA/MLA Format Download EndNote Download BibTex|
statistics & numerical data
Antihypertensive Agents / administration & dosage
Behavior Therapy / organization & administration*
Blood Pressure Determination
European Continental Ancestry Group / statistics & numerical data
Hypertension / diagnosis, ethnology*, therapy*
Medication Therapy Management / organization & administration*
Severity of Illness Index
Telemedicine / organization & administration*
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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