title: Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial.
abstract: BACKGROUND
  Given their high rates of uncontrolled blood pressure, urban African Americans comprise a particularly vulnerable subgroup of persons with hypertension. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multi-level interventions designed specifically to improve urban African American patients' blood pressure self-management by simultaneously leveraging patient, family, and community strengths are lacking.
  
  
  METHODS
  We report the protocol of the Achieving Blood Pressure Control Together (ACT) study, a randomized controlled trial designed to study the effectiveness of interventions that engage patient, family, and community-level resources to facilitate urban African American hypertensive patients' improved hypertension self-management and subsequent hypertension control. African American patients with uncontrolled hypertension receiving health care in an urban primary care clinic will be randomly assigned to receive 1) an educational intervention led by a community health worker alone, 2) the community health worker intervention plus a patient and family communication activation intervention, or 3) the community health worker intervention plus a problem-solving intervention. All participants enrolled in the study will receive and be trained to use a digital home blood pressure machine. The primary outcome of the randomized controlled trial will be patients' blood pressure control at 12months.
  
  
  CONCLUSIONS
  Results from the ACT study will provide needed evidence on the effectiveness of comprehensive multi-level interventions to improve urban African American patients' hypertension control.
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: pephraim@jhsph.edu.
authors: Patti L
authors: PL
authors: Ephraim
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA. Electronic address: fbriggs3@jhmi.edu.
authors: Felicia
authors: F
authors: Hill-Briggs
authors: Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: droter@jhsph.edu.
authors: Debra L
authors: DL
authors: Roter
authors: Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: lbone@jhsph.edu.
authors: Lee R
authors: LR
authors: Bone
authors: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: jwolff@jhsph.edu.
authors: Jennifer L
authors: JL
authors: Wolff
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: llewis3@jhmi.edu.
authors: LaPricia
authors: L
authors: Lewis-Boyer
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: dlevine@jhmi.edu.
authors: David M
authors: DM
authors: Levine
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute for Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: habouma1@jhmi.edu.
authors: Hanan J
authors: HJ
authors: Aboumatar
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: lisa.cooper@jhmi.edu.
authors: Lisa A
authors: LA
authors: Cooper
authors: Rush University Medical Center, Chicago, IL, USA. Electronic address: stephanie_fitzpatrick@rush.edu.
authors: Stephanie J
authors: SJ
authors: Fitzpatrick
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: kgudzun1@jhu.edu.
authors: Kimberly A
authors: KA
authors: Gudzune
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA. Electronic address: malber11@jhmi.edu.
authors: Michael C
authors: MC
authors: Albert
authors: Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Institute for Public Health Innovation, Washington, DC, USA. Electronic address: dymonroe@gmail.com.
authors: Dwyan
authors: D
authors: Monroe
authors: Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA. Electronic address: msimmons090349@gmail.com.
authors: Michelle
authors: M
authors: Simmons
authors: Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Sisters Together and Reaching, Baltimore, MD, USA. Electronic address: dhickman@sisterstogetherandreaching.org.
authors: Debra
authors: D
authors: Hickman
authors: Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; The Men's Center, Baltimore, MD, USA. Electronic address: lpurnell2003@yahoo.com.
authors: Leon
authors: L
authors: Purnell
authors: Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; American Heart Association, Baltimore, MD, USA. Electronic address: Annette.Fisher@heart.org.
authors: Annette
authors: A
authors: Fisher
authors: Union County Human Services, Monroe, NC, USA. Electronic address: Richard.Matens@co.union.nc.us.
authors: Richard
authors: R
authors: Matens
authors: Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Gary_Noronha@URMC.Rochester.edu.
authors: Gary J
authors: GJ
authors: Noronha
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: pfagan1@jhmi.edu.
authors: Peter J
authors: PJ
authors: Fagan
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: hramamu1@jhmi.edu.
authors: Hema C
authors: HC
authors: Ramamurthi
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jamelin1@jhmi.edu.
authors: Jessica M
authors: JM
authors: Ameling
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jeannec@jhmi.edu.
authors: Jeanne
authors: J
authors: Charlston
authors: The Brooklyn Hospital, Brooklyn, NY, USA. Electronic address: tssam1@yahoo.com.
authors: Tanyka S
authors: TS
authors: Sam
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: kcarson@jhmi.edu.
authors: Kathryn A
authors: KA
authors: Carson
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: naeyuh@jhmi.edu.
authors: Nae-Yuh
authors: NY
authors: Wang
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Nephrology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: dcrews1@jhmi.edu.
authors: Deidra C
authors: DC
authors: Crews
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rfcharle@jhmi.edu.
authors: Raquel C
authors: RC
authors: Greer
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: vlee2@jhmi.edu.
authors: Valerie
authors: V
authors: Sneed
authors: University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: sjflynn9@gmail.com.
authors: Sarah J
authors: SJ
authors: Flynn
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: ndepasqu@jhsph.edu.
authors: Nicole
authors: N
authors: DePasquale
authors: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. Electronic address: ebony.boulware@duke.edu.
authors: L Ebony
authors: LE
authors: Boulware
mesh_terms: D001741:Black or African American; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003142:Communication; D003150:Community Health Workers / Q000458:organization & administration; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D009042:Motivation; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D011340:Problem Solving; D012107:Research Design; D012648:Self Care / Q000379:methods*; D012944:Social Support; D012959:Socioeconomic Factors
keywords: Community health worker; Hypertension; Self-management