From the Division of Health and Behavior and Center for Healthful Behavior Change, Department of Population Health, New York University Langone Medical Center, New York, NY (G.O., S.F.); Clinical Directors Network, New York, NY (J.N.T., A.C., M.D.-G., C.K.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (J.N.T.); Center for Clinical and Translational Science, Rockefeller University, New York, NY (J.N.T.); Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (T.P., J.E.S.); Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY (J.E.S.).
Circulation. 2014 May 20;129(20):2044-51. doi: 10.1161/CIRCULATIONAHA.113.006650. Epub 2014 Mar 21.
Data are limited on the implementation of evidence-based multilevel interventions targeted at blood pressure (BP) control in hypertensive blacks who receive care in low-resource primary care practices.
Counseling African Americans to Control Hypertension is a cluster-randomized clinical trial in which 30 community health centers were randomly assigned to the intervention condition (IC) or usual care (UC). Patients at the IC sites received patient education, home BP monitoring, and monthly lifestyle counseling, whereas physicians attended monthly hypertension case rounds and received feedback on their patients' home BP readings and chart audits. Patients and physicians at the UC sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control, and secondary outcomes were mean changes in systolic and diastolic BPs at 12 months, assessed with an automated BP device. A total of 1059 patients (mean age, 56 years; 28% men, 59% obese, and 36% with diabetes mellitus) were enrolled. The BP control rate was similar in both groups (IC=49.3% versus UC=44.5%; odds ratio, 1.21 [95% confidence interval, 0.90-1.63]; P=0.21). In prespecified subgroup analyses, the intervention was associated with greater BP control in patients without diabetes mellitus (IC=54.0% versus UC=44.7%; odds ratio, 1.45 [confidence interval, 1.02-2.06]); and small-sized community health centers (IC=51.1% versus UC=39.6%; odds ratio, 1.45 [confidence interval, 1.04-2.45]).
A practice-based, multicomponent intervention was no better than UC in improving BP control among hypertensive blacks. Future research on the implementation of behavioral modification strategies for hypertension control in low-resource settings should focus on the development of more efficient and tailored interventions in this high-risk population.
http://www.clinicaltrials.gov. Unique identifier: NCT00233220.
在资源有限的基层医疗实践中，针对接受治疗的高血压黑人患者，实施以血压控制为目标的基于证据的多层次干预措施的数据有限。
“对非裔美国人进行高血压控制咨询”是一项以群组为基础的临床试验，其中 30 家社区健康中心被随机分配到干预组（IC）或常规护理（UC）。IC 点的患者接受患者教育、家庭血压监测和每月生活方式咨询，而医生则参加每月的高血压病例会议，并收到有关患者家庭血压读数和图表审核的反馈。UC 点的患者和医生分别接受了印刷的患者教育材料和高血压治疗指南。主要结果是血压控制，次要结果是 12 个月时收缩压和舒张压的平均变化，使用自动血压设备进行评估。共纳入 1059 例患者（平均年龄 56 岁；28%为男性，59%为肥胖，36%患有糖尿病）。两组的血压控制率相似（IC=49.3% vs. UC=44.5%；比值比，1.21[95%置信区间，0.90-1.63]；P=0.21）。在预先指定的亚组分析中，该干预措施与无糖尿病患者的血压控制更相关（IC=54.0% vs. UC=44.7%；比值比，1.45[置信区间，1.02-2.06]）和社区卫生中心规模较小（IC=51.1% vs. UC=39.6%；比值比，1.45[置信区间，1.04-2.45]）。
基于实践的多组分干预措施并不优于常规护理，无法改善高血压黑人的血压控制。未来在资源有限的环境中实施针对高血压控制的行为改变策略的研究，应重点针对这一高危人群制定更有效和定制化的干预措施。
