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

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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.

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Acknowledgments

We would like to thank our funding support from the Robert Wood Johnson Foundation and the staff of the Finding Answers, Disparities Research for Change Program. We also received an unrestricted grant from Pfizer, Inc., for the conduct of this study.

We would also like to thank the American Heart Association and especially Laura Dawson, Director, Cultural Health Initiatives, Great Rivers Affiliate, American Heart Association for her support throughout the project. We thank our peer coaches and community advisors, especially Mrs. Claire Walters, our lead peer coach, for her incredible talent and dedication to this project. We would like to also thank Josh Benner, PhD, for his assistance in the development of this project.

Conflict of Interest

The project received an unrestricted supplementary grant from Pfizer, Inc., to the University of Pennsylvania. The authors declare that they have no other conflicts.

Author information

Authors and Affiliations

  1. ReACH Center and Department of Medicine and Department of Family and Community Medicine, University of Texas Health Science Center San Antonio and University Health System, 7410 John Smith Road, Suite 1050, San Antonio, TX, 78229, USA

    Barbara J. Turner MD, MSED

  2. Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA, 17033, USA

    Christopher S. Hollenbeak PhD

  3. ReACH Center and Department of Epidemiology and Biostatistics and Department of Urology, University of Texas Health Science Center, San Antonio, TX, 78209, USA

    Yuanyuan Liang PhD

  4. School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA

    Yuanyuan Liang PhD

  5. University of Pennsylvania Undergraduate Program, Philadelphia, PA, 19104, USA

    Kavita Pandit BA & Shelly Joseph

  6. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA

    Mark G. Weiner MD

Authors
  1. Barbara J. Turner MD, MSED
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  2. Christopher S. Hollenbeak PhD
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  3. Yuanyuan Liang PhD
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  4. Kavita Pandit BA
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  5. Shelly Joseph
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  6. Mark G. Weiner MD
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Corresponding author

Correspondence to Barbara J. Turner MD, MSED.

Additional information

Trial Registration: (ClinicalTrials.gov number NCT00948714 Support for Cardiovascular Health in African American Primary Care Patients). Funded by the Robert Wood Johnson Foundation Informing Disparities program and Pfizer, Inc.

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Turner, B.J., Hollenbeak, C.S., Liang, Y. et al. A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension. J GEN INTERN MED 27, 1258–1264 (2012). https://doi.org/10.1007/s11606-012-2095-4

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  • DOI: https://doi.org/10.1007/s11606-012-2095-4

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