title: Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial.
abstract: OBJECTIVE
  To evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension.
  
  
  METHODS
  Cluster randomised trial involving four Dutch primary care centres and 146 patients (intervention n=75, control n=71), who met the following inclusion criteria: self-identified Surinamese or Ghanaian; ≥ 20 years; treated for hypertension; SBP ≥ 140 mmHg. All patients received usual hypertension care. The intervention-group was also offered three nurse-led, culturally appropriate hypertension education sessions. BP was assessed with Omron 705-IT and treatment adherence with lifestyle- and medication adherence scales.
  
  
  RESULTS
  139 patients (95%) completed the study (intervention n=71, control n=68). Baseline characteristics were largely similar for both groups. At six months, we observed a SBP reduction of ≥ 10 mmHg -primary outcome- in 48% of the intervention group and 43% of the control group. When adjusted for pre-specified covariates age, sex, hypertension duration, education, baseline measurement and clustering effect, the between-group difference was not significant (OR; 0.42; 95% CI: 0.11 to 1.54; P=0.19). At six months, the mean SBP/DBD had dropped by 10/5.7 (SD 14.3/9.2)mmHg in the intervention group and by 6.3/1.7 (SD 13.4/8.6)mmHg in the control group. After adjustment, between-group differences in SBP and DBP reduction were -1.69 mmHg (95% CI: -6.01 to 2.62, P=0.44) and -3.01 mmHg (-5.73 to -0.30, P=0.03) in favour of the intervention group. Mean scores for adherence to lifestyle recommendations increased in the intervention group, but decreased in the control group. Mean medication adherence scores improved slightly in both groups. After adjustment, the between-group difference for adherence to lifestyle recommendations was 0.34 (0.12 to 0.55; P=0.003). For medication adherence it was -0.09 (-0.65 to 0.46; P=0.74).
  
  
  CONCLUSIONS
  This intervention led to significant improvements in DBP and adherence to lifestyle recommendations, supporting the need for culturally appropriate hypertension care.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN35675524.
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Public Health, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Erik J A J
authors.initials: EJ
authors.lastname: Beune
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Beem
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jacob
authors.initials: J
authors.lastname: Mohrs
authors.affiliation: Department of Public Health, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Charles O
authors.initials: CO
authors.lastname: Agyemang
authors.affiliation: Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Joke A
authors.initials: JA
authors.lastname: Haafkens
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D016000:Cluster Analysis; D065246:Culturally Competent Care; D005260:Female; D005869:Ghana / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D040242:Risk Reduction Behavior; D013532:Suriname / Q000208:ethnology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents