Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC 27703, USA.
Am J Med. 2011 May;124(5):468.e1-8. doi: 10.1016/j.amjmed.2010.11.024.
Only one half of Americans have their blood pressure controlled, and there are significant racial differences in blood pressure control. The goal of this study was to examine the effectiveness of 2 patient-directed interventions designed to improve blood pressure control within white and non-white subgroups (African Americans, 49%).
Post hoc analysis of a 2 by 2 randomized trial with 2-year follow-up in 2 university-affiliated primary care clinics was performed. Within white and non-white patients (n=634), 4 groups were examined: 1) usual care; 2) home blood pressure monitoring (3 times per week); 3) tailored behavioral self-management intervention administered via telephone by a nurse every other month; and 4) a combination of the 2 interventions.
The overall race by time by treatment group effect suggested differential intervention effects on blood pressure over time for whites and non-whites (systolic blood pressure, P=. 08; diastolic blood pressure, P=.01). Estimated trajectories indicated that among the 308 whites, there was no significant effect on blood pressure at 12 or 24 months for any intervention compared with the control group. At 12 months, the non-whites (n=328) in all 3 intervention groups had systolic blood pressure decreases of 5.3 to 5.7 mm Hg compared with usual care (P <.05). At 24 months, in the combined intervention, non-whites had sustained lower systolic blood pressure compared with usual care (7.5 mm Hg; P <.02). A similar pattern was observed for diastolic blood pressure.
Combined home blood pressure monitoring and a tailored behavioral phone intervention seem to be particularly effective for improving blood pressure in non-white patients.
只有一半的美国人能够控制血压，而且血压控制在不同种族之间存在显著差异。本研究的目的是检验两种旨在改善白人和非白人亚组（非裔美国人占 49%）血压控制的患者导向干预措施的有效性。
对一项为期 2 年、有 2 年随访的 2×2 随机试验进行了事后分析，该试验在 2 所大学附属的初级保健诊所进行。在白人（n=634）和非白人患者（n=634）中，共检查了 4 组：1）常规护理；2）家庭血压监测（每周 3 次）；3）由护士每隔一个月通过电话提供的针对性行为自我管理干预；以及 4）两种干预的结合。
总体来看，种族与时间和治疗组的相互作用表明，干预措施对白人及非白人的血压在不同时间的影响存在差异（收缩压，P=.08；舒张压，P=.01）。估计轨迹表明，在 308 名白人中，与对照组相比，任何干预措施在 12 或 24 个月时对血压均无显著影响。在 12 个月时，所有 3 个干预组的非白人（n=328）的收缩压与常规护理相比下降了 5.3 至 5.7mmHg（P<.05）。在 24 个月时，与常规护理相比，联合干预组的非白人收缩压持续较低（7.5mmHg；P<.02）。舒张压也观察到类似的模式。
家庭血压监测与有针对性的行为电话干预相结合，似乎对改善非白人患者的血压特别有效。
