Underserved urban african american men: hypertension trial outcomes and mortality during 5 years.
BACKGROUND
African American men with hypertension (HTN) in low socioeconomic urban environments continue to achieve poor rates of HTN control.


METHODS
In a 5-year randomized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years, the effectiveness of a more intensive educational/behavioral/pharmacologic intervention provided by a nurse practitioner/community health worker/physician team was compared to less intensive information and referral intervention. Changes in behavioral factors, health care utilization, blood pressure (BP) control, left ventricular hypertrophy (LVH), and renal insufficiency were evaluated.


RESULTS
Follow-up rates exceeded 89% of available men. The ranges of mean annual systolic BP/diastolic BP change from the baseline to each year follow-up were -3.7 to -10.1/-4.9 to -12.3 mm Hg for the more intensive group and +3.4 to -3.0/-1.8 to -8.7 mm Hg for the less intensive group. The annual proportion of men with controlled BP (<140/90 mm Hg) ranged from 17% to 44% in the more intensive group and 21% to 36% in the less intensive group. At 5 years the more intensive group had less LVH than the less intensive group and 17% of the men were deceased primarily due to narcotic or alcohol intoxication (36%) and cardiovascular causes (19%).


CONCLUSIONS
An appropriate educational/behavioral intervention significantly improved BP control and reduced some sequelae of HTN in a young African American male population. Improvement in risk factors other than HTN was limited and sustained control of HTN was difficult to maintain during 5 years.
Dennison
Cheryl R
CR
School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA. cdennis4@jhmi.edu
Post
Wendy S
WS
Kim
Miyong T
MT
Bone
Lee R
LR
Cohen
David
D
Blumenthal
Roger S
RS
Rame
J Eduardo
JE
Roary
Mary C
MC
Levine
David M
DM
Hill
Martha N
MN
D000328:Adult; D001741:Black or African American; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003401:Creatine / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000451:nursing*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis; D015996:Survival Rate; D016896:Treatment Outcome; D014505:Urban Population
D003401:Creatine