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Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

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ABSTRACT

BACKGROUND

African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events.

OBJECTIVE

The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program.

PARTICIPANTS

Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial.

INTERVENTIONS

Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values.

MAIN MEASURES

Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure).

KEY RESULTS

Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p = 0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p = 0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p = 0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients.

CONCLUSIONS

The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.

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Acknowledgements

Sources of Funding

This research is supported by a grant from Veterans Affairs, Health Services Research and Development (VA HSR&D) (IIR 04-426). Dr. Bosworth is supported by a VA HSR&D Research Career Scientist award (RCS 08-027) and an Established Investigator Award from American Heart Association. Dr. Powers is supported by a VA HSR&D Career Development Award (CDA 09-212). ATHENA-HTN development and testing was supported in part by VA HSR&D (CPI 99-275, IMV-04-062).

Conflict of Interest

The authors declare that they do not have a conflict of interest. All authors are employees of the Department of Veterans Affairs. No author received compensation for preparation of this manuscript, apart from his or her employment.

Disclaimer

The views expressed in this article are those of the authors, and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States government, or Duke University.

Author information

Authors and Affiliations

  1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    George L. Jackson PhD., MHA, Eugene Z. Oddone MD, MHSc, Maren K Olsen PhD., Benjamin J. Powers MD, MHS, Janet M. Grubber MSPH, Felicia McCant MSSW & Hayden B. Bosworth PhD.

  2. Division of General Internal Medicine, Duke University, Durham, NC, USA

    George L. Jackson PhD., MHA, Eugene Z. Oddone MD, MHSc, Benjamin J. Powers MD, MHS, Janet M. Grubber MSPH & Hayden B. Bosworth PhD.

  3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Maren K Olsen PhD.

  4. Department of Psychiatry and Behavioral Sciences; School of Nursing, Duke University, Durham, NC, USA

    Hayden B. Bosworth PhD.

  5. Durham VA Medical Center HSR&D Service (152), 508 Fulton Street, Durham, NC, 27705, USA

    George L. Jackson PhD., MHA

Authors
  1. George L. Jackson PhD., MHA
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  2. Eugene Z. Oddone MD, MHSc
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  3. Maren K Olsen PhD.
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  4. Benjamin J. Powers MD, MHS
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  7. Hayden B. Bosworth PhD.
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Corresponding author

Correspondence to George L. Jackson PhD., MHA.

Additional information

Clinical Trial Registration

Trial Registration: ClinicalTrials.gov

Clinical Trials Registration #: NCT00237692

Registry URL: http://www.clinicaltrials.gov

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Jackson, G.L., Oddone, E.Z., Olsen, M.K. et al. Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program. J GEN INTERN MED 27, 1682–1689 (2012). https://doi.org/10.1007/s11606-012-2138-x

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  • DOI: https://doi.org/10.1007/s11606-012-2138-x

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