Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

Abstract

(152), Durham, NC, USA.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. PARTICIPANTS: 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. INTERVENTIONS: Study arms included: 1) nurseadministered, 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. MAIN MEASURES: 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). KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African Ameri-

Patient characteristics associated with greater blood pressure control in a randomized trial of home blood pressure telemonitoring and pharmacist management

“…18,19 In a nurse-managed intervention in the VA setting, Jackson, et al reported that the intervention effect was confined to African American patients. 20 Although we did not observe significant interactions by baseline SBP level or race, our results extend these previous reports and provide useful information on subgroups that also suggests likely mechanisms by which our intervention, and perhaps similar interventions designed by others, may exert their beneficial effects.…”

Physician–Pharmacist Collaborative Management

“…30 A similar study in two internal medicine clinics in North Carolina found that a behavioral intervention and home BP monitoring was more effective in non-white patients than whites. 31 A nurse led intervention tailored specifically to blacks and Hispanics in Harlem, NY found a significant reduction in systolic BP in comparison to usual care.…”

Hypertension in Blacks

“…73 The inclusion of technology-based or mobile health (mHealth) interventions 74, 75 should be considered to test whether they can enhance culturally-appropriate community-based programs. This can include telephone-delivered hypertension management programs 76, 77 in conjunction with HBPM, or ABPM and/or mobile phone text messaging to support medication adherence. 78, 79 Smartphone technology can also be used to facilitate data collection, including ecological momentary assessments among JHS participants between study visits and deliver or re-emphasize healthcare education 80 and lifestyle interventions.…”