title: Racial differences in the effect of a telephone-delivered hypertension disease management program.
abstract: BACKGROUND
  African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events.
  
  
  OBJECTIVE
  The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program.
  
  
  METHODS
  Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial.
  
  
  METHODS
  Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values.
  
  
  METHODS
  Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure).
  
  
  RESULTS
  Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p=0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p=0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p=0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients.
  
  
  CONCLUSIONS
  The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. george.l.jackson@duke.edu
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
authors.forename: Janet M
authors.initials: JM
authors.lastname: Grubber
authors.forename: Felicia
authors.initials: F
authors.lastname: McCant
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001521:Behavior Therapy / Q000458:organization & administration*; D001795:Blood Pressure Determination; D016001:Confidence Intervals; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D009657:North Carolina; D015397:Program Evaluation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013685:Telecommunications; D017216:Telemedicine / Q000458:organization & administration*; D013689:Telephone; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents