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Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.

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Boulware, LE; Ephraim, PL; Hill-Briggs, F; Roter, DL; Bone, LR; Wolff, JL; Lewis-Boyer, L; Levine, DM; Greer, RC; Crews, DC; Gudzune, KA ...
Published in: J Gen Intern Med
January 2020

BACKGROUND: Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. OBJECTIVE: We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. DESIGN: Randomized comparative effectiveness trial. PARTICIPANTS: One hundred fifty-nine African Americans at an urban primary care clinic. INTERVENTIONS: Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). MAIN MEASURES: We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. KEY RESULTS: BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. CONCLUSION: A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT01902719.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

January 2020

Volume

35

Issue

1

Start / End Page

142 / 152

Location

United States

Related Subject Headings

  • Vulnerable Populations
  • Self-Management
  • Hypertension
  • Humans
  • General & Internal Medicine
  • Blood Pressure
  • Black or African American
  • Antihypertensive Agents
  • 4206 Public health
  • 4203 Health services and systems
 

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Boulware, L. E., Ephraim, P. L., Hill-Briggs, F., Roter, D. L., Bone, L. R., Wolff, J. L., … Cooper, L. A. (2020). Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial. J Gen Intern Med, 35(1), 142–152. https://doi.org/10.1007/s11606-019-05396-7
Boulware, L Ebony, Patti L. Ephraim, Felicia Hill-Briggs, Debra L. Roter, Lee R. Bone, Jennifer L. Wolff, LaPricia Lewis-Boyer, et al. “Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.J Gen Intern Med 35, no. 1 (January 2020): 142–52. https://doi.org/10.1007/s11606-019-05396-7.
Boulware LE, Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, et al. Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial. J Gen Intern Med. 2020 Jan;35(1):142–52.
Boulware, L. Ebony, et al. “Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.J Gen Intern Med, vol. 35, no. 1, Jan. 2020, pp. 142–52. Pubmed, doi:10.1007/s11606-019-05396-7.
Boulware LE, Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, Lewis-Boyer L, Levine DM, Greer RC, Crews DC, Gudzune KA, Albert MC, Ramamurthi HC, Ameling JM, Davenport CA, Lee H-J, Pendergast JF, Wang N-Y, Carson KA, Sneed V, Gayles DJ, Flynn SJ, Monroe D, Hickman D, Purnell L, Simmons M, Fisher A, DePasquale N, Charleston J, Aboutamar HJ, Cabacungan AN, Cooper LA. Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial. J Gen Intern Med. 2020 Jan;35(1):142–152.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

January 2020

Volume

35

Issue

1

Start / End Page

142 / 152

Location

United States

Related Subject Headings

  • Vulnerable Populations
  • Self-Management
  • Hypertension
  • Humans
  • General & Internal Medicine
  • Blood Pressure
  • Black or African American
  • Antihypertensive Agents
  • 4206 Public health
  • 4203 Health services and systems