Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial

Patti L Ephraim; Felicia Hill-Briggs; Debra L Roter; Lee R Bone; Jennifer L Wolff; LaPricia Lewis-Boyer; David M Levine; Hanan J Aboumatar; Lisa A Cooper; Stephanie J Fitzpatrick; Kimberly A Gudzune; Michael C Albert; Dwyan Monroe; Michelle Simmons; Debra Hickman; Leon Purnell; Annette Fisher; Richard Matens; Gary J Noronha; Peter J Fagan; Hema C Ramamurthi; Jessica M Ameling; Jeanne Charlston; Tanyka S Sam; Kathryn A Carson; Nae-Yuh Wang; Deidra C Crews; Raquel C Greer; Valerie Sneed; Sarah J Flynn; Nicole DePasquale; L Ebony Boulware

doi:10.1016/j.cct.2014.06.009

Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial

Contemp Clin Trials. 2014 Jul;38(2):370-82. doi: 10.1016/j.cct.2014.06.009. Epub 2014 Jun 21.

Authors

Patti L Ephraim¹, Felicia Hill-Briggs², Debra L Roter³, Lee R Bone⁴, Jennifer L Wolff⁵, LaPricia Lewis-Boyer⁶, David M Levine⁷, Hanan J Aboumatar⁸, Lisa A Cooper⁹, Stephanie J Fitzpatrick¹⁰, Kimberly A Gudzune¹¹, Michael C Albert¹², Dwyan Monroe¹³, Michelle Simmons¹⁴, Debra Hickman¹⁵, Leon Purnell¹⁶, Annette Fisher¹⁷, Richard Matens¹⁸, Gary J Noronha¹⁹, Peter J Fagan²⁰, Hema C Ramamurthi²¹, Jessica M Ameling²², Jeanne Charlston²³, Tanyka S Sam²⁴, Kathryn A Carson²⁵, Nae-Yuh Wang²⁶, Deidra C Crews²⁷, Raquel C Greer²⁸, Valerie Sneed²⁹, Sarah J Flynn³⁰, Nicole DePasquale³¹, L Ebony Boulware³²

Affiliations

¹ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
² Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA. Electronic address: [email protected].
³ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
⁴ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
⁵ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
⁶ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁷ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁸ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute for Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: [email protected].
⁹ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
¹⁰ Rush University Medical Center, Chicago, IL, USA. Electronic address: [email protected].
¹¹ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
¹² Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA. Electronic address: [email protected].
¹³ Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Institute for Public Health Innovation, Washington, DC, USA. Electronic address: [email protected].
¹⁴ Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA. Electronic address: [email protected].
¹⁵ Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Sisters Together and Reaching, Baltimore, MD, USA. Electronic address: [email protected].
¹⁶ Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; The Men's Center, Baltimore, MD, USA. Electronic address: [email protected].
¹⁷ Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; American Heart Association, Baltimore, MD, USA. Electronic address: [email protected].
¹⁸ Union County Human Services, Monroe, NC, USA. Electronic address: [email protected].
¹⁹ Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: [email protected].
²⁰ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
²¹ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
²² Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
²³ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
²⁴ The Brooklyn Hospital, Brooklyn, NY, USA. Electronic address: [email protected].
²⁵ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
²⁶ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
²⁷ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Nephrology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: [email protected].
²⁸ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
²⁹ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
³⁰ University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
³¹ Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
³² Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. Electronic address: [email protected].

Abstract

Background: Given their high rates of uncontrolled blood pressure, urban African Americans comprise a particularly vulnerable subgroup of persons with hypertension. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multi-level interventions designed specifically to improve urban African American patients' blood pressure self-management by simultaneously leveraging patient, family, and community strengths are lacking.

Methods/design: We report the protocol of the Achieving Blood Pressure Control Together (ACT) study, a randomized controlled trial designed to study the effectiveness of interventions that engage patient, family, and community-level resources to facilitate urban African American hypertensive patients' improved hypertension self-management and subsequent hypertension control. African American patients with uncontrolled hypertension receiving health care in an urban primary care clinic will be randomly assigned to receive 1) an educational intervention led by a community health worker alone, 2) the community health worker intervention plus a patient and family communication activation intervention, or 3) the community health worker intervention plus a problem-solving intervention. All participants enrolled in the study will receive and be trained to use a digital home blood pressure machine. The primary outcome of the randomized controlled trial will be patients' blood pressure control at 12months.

Discussion: Results from the ACT study will provide needed evidence on the effectiveness of comprehensive multi-level interventions to improve urban African American patients' hypertension control.

Keywords: Community health worker; Hypertension; Self-management.

Publication types

Randomized Controlled Trial

MeSH terms

Black or African American*
Blood Pressure
Blood Pressure Determination
Communication
Community Health Workers / organization & administration
Female
Health Knowledge, Attitudes, Practice
Humans
Hypertension / ethnology*
Hypertension / therapy*
Male
Motivation
Patient Education as Topic / organization & administration
Primary Health Care / organization & administration
Problem Solving
Research Design*
Self Care / methods*
Social Support
Socioeconomic Factors

Abstract

Publication types

MeSH terms

Grants and funding