Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1258–1264

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

Authors

    • ReACH Center and Department of Medicine and Department of Family and Community MedicineUniversity of Texas Health Science Center San Antonio and University Health System
  • Christopher S. Hollenbeak
    • Departments of Surgery and Public Health SciencesPenn State College of Medicine
  • Yuanyuan Liang
    • ReACH Center and Department of Epidemiology and Biostatistics and Department of UrologyUniversity of Texas Health Science Center
    • School of Public HealthUniversity of Texas Health Science Center at Houston
  • Kavita Pandit
    • University of Pennsylvania Undergraduate Program
  • Shelly Joseph
    • University of Pennsylvania Undergraduate Program
  • Mark G. Weiner
    • Department of MedicineUniversity of Pennsylvania School of Medicine
Original Research

DOI: 10.1007/s11606-012-2095-4

Cite this article as:
Turner, B.J., Hollenbeak, C.S., Liang, Y. et al. J GEN INTERN MED (2012) 27: 1258. doi:10.1007/s11606-012-2095-4

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.

KEY WORDS

coronary heart diseasehypertensionAfrican Americanpeer support

Copyright information

© Society of General Internal Medicine 2012