title: Racial differences in two self-management hypertension interventions.
abstract: BACKGROUND
  Only one half of Americans have their blood pressure controlled, and there are significant racial differences in blood pressure control. The goal of this study was to examine the effectiveness of 2 patient-directed interventions designed to improve blood pressure control within white and non-white subgroups (African Americans, 49%).
  
  
  METHODS
  Post hoc analysis of a 2 by 2 randomized trial with 2-year follow-up in 2 university-affiliated primary care clinics was performed. Within white and non-white patients (n=634), 4 groups were examined: 1) usual care; 2) home blood pressure monitoring (3 times per week); 3) tailored behavioral self-management intervention administered via telephone by a nurse every other month; and 4) a combination of the 2 interventions.
  
  
  RESULTS
  The overall race by time by treatment group effect suggested differential intervention effects on blood pressure over time for whites and non-whites (systolic blood pressure, P=. 08; diastolic blood pressure, P=.01). Estimated trajectories indicated that among the 308 whites, there was no significant effect on blood pressure at 12 or 24 months for any intervention compared with the control group. At 12 months, the non-whites (n=328) in all 3 intervention groups had systolic blood pressure decreases of 5.3 to 5.7 mm Hg compared with usual care (P <.05). At 24 months, in the combined intervention, non-whites had sustained lower systolic blood pressure compared with usual care (7.5 mm Hg; P <.02). A similar pattern was observed for diastolic blood pressure.
  
  
  CONCLUSIONS
  Combined home blood pressure monitoring and a tailored behavioral phone intervention seem to be particularly effective for improving blood pressure in non-white patients.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC 27703, USA. hboswort@acpub.duke.edu
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Janet M
authors.initials: JM
authors.lastname: Grubber
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory; D015986:Confounding Factors, Epidemiologic; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology* / Q000628:therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012648:Self Care; D013689:Telephone; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents