title: A randomized trial of peer coach and office staff support to reduce coronary heart disease risk in African-Americans with uncontrolled hypertension.
abstract: OBJECTIVE
  Adopting features of the Chronic Care Model may reduce coronary heart disease risk and blood pressure in vulnerable populations. We evaluated a peer and practice team intervention on reduction in 4-year coronary heart disease risk and systolic blood pressure.
  
  
  METHODS
  A single blind, randomized, controlled trial in two adjacent urban university-affiliated primary care practices. Two hundred eighty African-American subjects aged 40 to 75 with uncontrolled hypertension.
  
  
  METHODS
  Three monthly calls from trained peer patients with well-controlled hypertension and, on alternate months, two practice staff visits to review a personalized 4-year heart disease risk calculator and slide shows about heart disease risks. All subjects received usual physician care and brochures about healthy cooking and heart disease.
  
  
  METHODS
  Change in 4-year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months.
  
  
  RESULTS
  At baseline, the 136 intervention and 144 control subjects' mean 4-year coronary heart disease risk did not differ (intervention=5.8 % and control=6.4 %, P=0.39), and their mean systolic blood pressure was the same (140.5 mmHg, p=0.83). Endpoint data for coronary heart disease were obtained for 69 % of intervention and 82 % of control subjects. After multiple imputation for missing endpoint data, the reduction in risk among all 280 subjects favored the intervention, but was not statistically significant (difference -0.73 %, 95 % confidence interval: -1.54 % to 0.09 %, p=0.08). Among the 247 subjects with a systolic blood pressure endpoint (85 % of intervention and 91 % of control subjects), more intervention than control subjects achieved a >5 mmHg reduction (61 % versus 45 %, respectively, p=0.01). After multiple imputation, the absolute reduction in systolic blood pressure was also greater for the intervention group (difference -6.47 mmHg, 95 % confidence interval: -10.69 to -2.25, P=0.003). One patient died in each study arm.
  
  
  CONCLUSIONS
  Peer patient and office-based behavioral support for African-American patients with uncontrolled hypertension did not result in a significantly greater reduction in coronary heart disease risk but did significantly reduce systolic blood pressure.
authors.affiliation: ReACH Center and Department of Medicine and Department of Family and Community Medicine, University of Texas Health Science Center San Antonio and University Health System, 7410 John Smith Road, Suite 1050, San Antonio, TX 78229, USA. turner@uthscsa.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liang
authors.forename: Kavita
authors.initials: K
authors.lastname: Pandit
authors.forename: Shelly
authors.initials: S
authors.lastname: Joseph
authors.forename: Mark G
authors.initials: MG
authors.lastname: Weiner
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology* / Q000523:psychology; D000368:Aged; D003327:Coronary Disease / Q000208:ethnology* / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D012307:Risk Factors; D016037:Single-Blind Method