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A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension

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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.

DESIGN AND SUBJECTS

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.

INTERVENTION

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.

MAIN MEASURES

Change in 4-year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months.

KEY 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.

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References

  1. Centers for Disease Control and Prevention. National Vital Statistic Report. Vol. 57, Num 14 Table B. http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf, accessed Jan 5, 2012.

  2. Centers for Disease Control and Prevention. Health United States, 2008. Table 71. http://www.cdc.gov/nchs/data/hus/hus08.pdf, accessed Jan 5, 2012.

  3. Kramer H, Han C, Post W, Goff D, Diez-Roux A, Cooper R, Jinagouda S, Shea S. Racial-ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA). Am J Hypertens. 2004;17(10):963–70.

    Article  PubMed  Google Scholar 

  4. Umscheid CA, Gross R, Weiner MG, Hollenbeak CS, Tang SS, Turner BJ. Racial disparities in hypertension control, but not treatment intensification. Am J Hypertens. 2010;23(1):54–61.

    Article  PubMed  Google Scholar 

  5. Bosworth HB, Powers B, Grubber JM, Thorpe CT, Olsen MK, Orr M, et al. Racial differences in blood pressure control: potential explanatory factors. J Gen Intern Med. 2008;23(5):692–8.

    Article  PubMed  Google Scholar 

  6. Bokhour BG, Berlowitz DR, Long JA, Kressin NR. How do providers assess antihypertensive medication adherence in medical encounters? J Gen Intern Med. 2006;21:577–83.

    Article  PubMed  Google Scholar 

  7. Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009;28(1):75–85.

    Article  Google Scholar 

  8. Moy E, Valente E Jr, Levin RJ, Griner PF. Academic medical centers and the care of underserved populations. Acad Med. 1996;71(12):1370–7.

    Article  PubMed  CAS  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  PubMed  CAS  Google Scholar 

  10. Turner BJ, Weiner M, Yang C, TenHave T. Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior. Ann Intern Med. 2004;140:528–32.

    PubMed  Google Scholar 

  11. Turner BJ, Hollenbeak C, Weiner MG, Ten Have T, Roberts C. Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients. Pharmacoepidemiol Drug Safe. 2009;18:672–81.

    Article  Google Scholar 

  12. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.

    Article  PubMed  CAS  Google Scholar 

  13. Azjen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.

    Article  Google Scholar 

  14. Miller WR, Rollnick S. Motivational Interviewing: preparing People for Change. 2nd ed. New York: Guilford Press; 2002.

    Google Scholar 

  15. D'Agostino RB, Russell MW, Huse DM, Ellison RC, Silbershatz H, Wilson PW, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000;139(2 Pt 1):272–81. Erratum in: Am Heart J. 2002;143(1):21.

  16. Benner JS, Erhardt L, Flammer M, Moller RA, Rajicic N, Changela K, et al. A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile. Int J Clin Pract. 2008;62(10):1484–98.

    Article  PubMed  CAS  Google Scholar 

  17. Shaffer ML, Chinchilli VM. Including multiple imputation in a sensitivity analysis for clinical trials with treatment failures. Contemp Clin Trials. 2007;28(2):130–7.

    Article  PubMed  Google Scholar 

  18. Raghunathan TW, Lepkowksi JM, Van Hoewyk J, Solenbeger P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol. 2001;27:85–95.

    Google Scholar 

  19. Rubin DB. Multiple Imputation for Nonresponse in Surveys. New York: John Wiley and Sons; 1987.

    Book  Google Scholar 

  20. Barg FK, Weiner MG, Joseph S, Pandit K, Turner BJ. Qualitative analysis of peer coaches' experiences with counseling African Americans about reducing heart disease risk. J Gen Intern Med. 2012;27(2):167–72.

    Article  PubMed  Google Scholar 

  21. Houston TK, Allison JJ, Sussman M, Horn W, Holt CL, Trobaugh J, et al. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2011;154(2):77–84.

    PubMed  Google Scholar 

  22. Wu J, Kraja AT, Oberman A, Lewis CE, Ellison RC, Arnett DK, et al. A summary of the effects of antihypertensive medications on measured blood pressure. Am J Hypertens. 2005;18:935–42.

    Article  PubMed  CAS  Google Scholar 

  23. Heisler M, Vijan S, Makki F, Piette JD. Diabetes control with reciprocal peer support versus nurse care management: a randomized trial. Ann Intern Med. 2010;153(8):507–15.

    PubMed  Google Scholar 

  24. Smith SM, Paul G, Kelly A, Whitford DL, O'Shea E, O'Dowd T. Peer support for patients with type 2 diabetes: cluster randomised controlled trial. BMJ. 2011;342. doi:10.1136/bmj.d715.

  25. Kressin NR, Orner MB, Manze M, Glickman ME, Berlowitz D. Understanding contributors to racial disparities in blood pressure control. Circ Cardiovasc Qual Outcomes. 2010;3(2):173–80.

    Article  PubMed  Google Scholar 

  26. Koelewijn-van Loon MS, van der Weijden T, Ronda G, van Steenkiste B, Winkens B, Elwyn G, et al. Improving lifestyle and risk perception through patient involvement in nurse-led cardiovascular risk management: a cluster-randomized controlled trial in primary care. Prev Med. 2010;50(1–2):35–44.

    Article  PubMed  Google Scholar 

  27. Svetkey LP, Pollak KI, Yancy WS Jr, Dolor RJ, Batch BC, Samsa G, et al. Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients. Hypertension. 2009;54(6):1226–33.

    Article  PubMed  CAS  Google Scholar 

  28. Centers for Disease Control and Prevention. CDC health disparities and inequality report–United States 2011. MMWR. 2011;60(Suppl):1–20.

    Google Scholar 

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Acknowledgments

We would like to thank our funding support from the Robert Wood Johnson Foundation and the staff of the Finding Answers, Disparities Research for Change Program. We also received an unrestricted grant from Pfizer, Inc., for the conduct of this study.

We would also like to thank the American Heart Association and especially Laura Dawson, Director, Cultural Health Initiatives, Great Rivers Affiliate, American Heart Association for her support throughout the project. We thank our peer coaches and community advisors, especially Mrs. Claire Walters, our lead peer coach, for her incredible talent and dedication to this project. We would like to also thank Josh Benner, PhD, for his assistance in the development of this project.

Conflict of Interest

The project received an unrestricted supplementary grant from Pfizer, Inc., to the University of Pennsylvania. The authors declare that they have no other conflicts.

Author information

Authors and Affiliations

  1. 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

    Barbara J. Turner MD, MSED

  2. Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA, 17033, USA

    Christopher S. Hollenbeak PhD

  3. ReACH Center and Department of Epidemiology and Biostatistics and Department of Urology, University of Texas Health Science Center, San Antonio, TX, 78209, USA

    Yuanyuan Liang PhD

  4. School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA

    Yuanyuan Liang PhD

  5. University of Pennsylvania Undergraduate Program, Philadelphia, PA, 19104, USA

    Kavita Pandit BA & Shelly Joseph

  6. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA

    Mark G. Weiner MD

Authors
  1. Barbara J. Turner MD, MSED
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  2. Christopher S. Hollenbeak PhD
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  3. Yuanyuan Liang PhD
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  4. Kavita Pandit BA
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  5. Shelly Joseph
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  6. Mark G. Weiner MD
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Corresponding author

Correspondence to Barbara J. Turner MD, MSED.

Additional information

Trial Registration: (ClinicalTrials.gov number NCT00948714 Support for Cardiovascular Health in African American Primary Care Patients). Funded by the Robert Wood Johnson Foundation Informing Disparities program and Pfizer, Inc.

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Turner, B.J., Hollenbeak, C.S., Liang, Y. et al. A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension. J GEN INTERN MED 27, 1258–1264 (2012). https://doi.org/10.1007/s11606-012-2095-4

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  • DOI: https://doi.org/10.1007/s11606-012-2095-4

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