Original Research

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

  • Barbara J. TurnerAffiliated withReACH Center and Department of Medicine and Department of Family and Community Medicine, University of Texas Health Science Center San Antonio and University Health System Email author 
  • , Christopher S. HollenbeakAffiliated withDepartments of Surgery and Public Health Sciences, Penn State College of Medicine
  • , Yuanyuan LiangAffiliated withReACH Center and Department of Epidemiology and Biostatistics and Department of Urology, University of Texas Health Science CenterSchool of Public Health, University of Texas Health Science Center at Houston
  • , Kavita PanditAffiliated withUniversity of Pennsylvania Undergraduate Program
  • , Shelly JosephAffiliated withUniversity of Pennsylvania Undergraduate Program
  • , Mark G. WeinerAffiliated withDepartment of Medicine, University of Pennsylvania School of Medicine

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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 disease hypertension African American peer support