Hypertension care and control in underserved urban African American men: behavioral and physiologic outcomes at 36 months.
BACKGROUND
African American men with hypertension in low socioeconomic urban populations achieve poor rates of hypertension control and suffer early from its complications.


METHODS
In a randomized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years, we evaluated the effectiveness of a more intensive comprehensive educational-behavioral-pharmacologic intervention by a nurse practitioner-community health worker-physician (NP/CHW/MD) team and a less intensive education and referral intervention in controlling blood pressure (BP) and minimizing progression of left ventricular hypertrophy (LVH) and renal insufficiency. Changes in BP, left ventricular mass (LVM), and serum creatinine from baseline to 36 months were compared between groups.


RESULTS
At 36 months, the mean systolic BP/diastolic BP change from baseline was -7.5/-10.1 mm Hg for the more intensive group and +3.4/-3.7 mm Hg for the less intensive group (P =.001 and.005 for between-group differences in systolic BP and diastolic BP, respectively). The proportion of men with controlled BP (<140/90 mm Hg) was 44% in the more intensive group and 31% in the less intensive group (P =.045). The LVM was significantly lower in the more intensive group than in the less intensive group (more intensive, 274 g; less intensive, 311 g; P =.004). There was a trend toward slowing of the progression of renal insufficiency (incidence of 50% increase in serum creatinine) in the more intensive group compared to the less intensive group (more intensive, 5.2%; less intensive, 8.0%; P =.08).


CONCLUSIONS
During 36 months, the more intensive intervention led to a lower BP and decreased progression of LVH in a sample of hypertensive young African American men.
Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2110, USA. mnhill@son.jhmi.edu
Martha N
MN
Hill
Hae-Ra
HR
Han
Cheryl R
CR
Dennison
Miyong T
MT
Kim
Mary C
MC
Roary
Roger S
RS
Blumenthal
Lee R
LR
Bone
David M
DM
Levine
Wendy S
WS
Post
D000328:Adult; D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015142:Baltimore; D001794:Blood Pressure; D003153:Community Health Services / Q000379:methods* / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000517:prevention & control; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009722:Nurse Practitioners; D010353:Patient Education as Topic; D011203:Poverty; D014505:Urban Population
D000959:Antihypertensive Agents; D003404:Creatinine