School of Medicine, University of Maryland, Baltimore, MD, USA.
J Clin Hypertens (Greenwich). 2011 Aug;13(8):563-70. doi: 10.1111/j.1751-7176.2011.00477.x. Epub 2011 Jun 28.
Hypertension is a major risk factor for developing cardiovascular disease and is more prevalent in African Americans compared with Caucasians. African Americans are often underrepresented in clinical trials. This study was composed of a largely urban African American cohort of hypertensive patients. This was a prospective, 4-arm, randomized controlled trial designed to evaluate the comparative effectiveness of both physician and patient education (PPE), patient education only (PAE), and physician education only (PHE) vs usual care (UC). Hypertension specialists gave a series of didactic lectures to the physicians, while a nurse educator performed the patient education. The mean adjusted difference in systolic blood pressure (SBP) from baseline in the PPE group was an average reduction of 12 mm Hg (95% confidence interval [CI], -4.5 to -19.4) at 6-months, followed by average reductions of 4.6 mm Hg (6.9 to -16.12) in the PAE group, 4.1 mm Hg (3.4 to -11.7) in the PHE group, and 2.6 mm Hg (3 to -8.2) in the UC group. The PPE group achieved a significantly better reduction in SBP compared with the UC group. Additional research should be conducted to evaluate whether the use of certified hypertension educators in collaboration with physicians will result in a similar blood pressure reduction.
高血压是导致心血管疾病的一个主要危险因素,非裔美国人患高血压的比例比白种人高。非裔美国人在临床试验中的代表性往往不足。本研究纳入了一个主要由城市非裔美国人高血压患者组成的队列。这是一项前瞻性、四臂、随机对照试验,旨在评估医生和患者教育(PPE)、仅患者教育(PAE)、仅医生教育(PHE)与常规护理(UC)的相对有效性。高血压专家为医生们举办了一系列讲座,而一名护士教育者则进行患者教育。在 PPE 组中,从基线开始的收缩压(SBP)的平均调整差异在 6 个月时平均降低了 12mmHg(95%置信区间[CI],-4.5 至-19.4),随后在 PAE 组中平均降低了 4.6mmHg(6.9 至-16.12),在 PHE 组中平均降低了 4.1mmHg(3.4 至-11.7),在 UC 组中平均降低了 2.6mmHg(3 至-8.2)。与 UC 组相比,PPE 组的 SBP 降低更为显著。应开展更多研究来评估是否在医生的协作下使用认证高血压教育者会带来类似的血压降低效果。