November 10, 1999
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Personalized care and attention given by a research team can lower high blood pressure significantly in urban black men, researchers at Johns Hopkins University School of Nursing report.
Results of a two-year study of 309 hypertensive, urban African American men ages 18 to 54 show blood pressure control rates improved in this high-risk population by 105 percent. Results will be presented at 12:15 p.m., Nov. 10, at the American Heart Association's 72nd Annual Scientific Sessions in Atlanta.
"We can never underestimate the power of reaching out and offering attention," says Martha N. Hill, Ph.D., R.N., professor of nursing and principal investigator. "This study is especially significant because it targeted some of the most vulnerable black men who are at very high risk for the effects of uncontrolled blood pressure such as stroke, heart failure and kidney failure. Members of this population bear social, economic, environmental and educational burdens that make it difficult to participate in regular medical care or make behavioral changes for health improvement."
In the study, two levels of personalized care were tested. Half of the men received a more intensive care and outreach that included a home visit, free medication, hypertension education, transportation assistance and referrals. The other half were given hypertension education, and referrals to medical care and free health care in the community. Men in both groups received telephone interviews twice a year, annual evaluations of their heart and kidney function, and regular correspondence such as birthday and holiday cards. Surprisingly, researchers said, men in both groups had blood pressure control rates averaging 39 percent, topping the overall national control rate of 27 percent. Men who received the team intervention had a slightly higher improvement rate. Eighty-four percent of the men remained in the study for the entire two years.
The men in the more intensive intervention group received care from a team consisting of a nurse practitioner, a community health worker and a physician. The nurse practitioner managed blood pressure control, provided free medication and consulted with the physician. The community health worker assisted the men in getting housing or medical assistance and referred them to social services in the community.
The men in the group referred to care in the community increased their participation in care, and more men were taking high blood pressure medication than at the beginning of the study, Hill said.
"Sustaining improved blood pressure rates over time remains a complex challenge," says Hill. "Young urban black men have long been thought not to care about their health or participate in research studies. We have found that this is not true. Many said this was the first time they have been contacted by any health care organization and offered preventive services. Not only is this population interested in their health, but they want help and will accept help if it is provided in a sensitive and non-judgmental way that addresses their social, economic and environmental stresses."
The study was funded by the National Institute of Nursing Research (NIH), the National Center of Research Resources (NIH), WA Baum and Co. Inc., and Merck & Co.
Other authors of the study include Miyong Kim, Linda Rose, Cheryl Dennison (Hopkins School of Nursing), Roger Blumenthal, Gary Gerstenblith, David Levine, Wendy Post, James Weiss (Hopkins School of Medicine), and Lee Bone (Hopkins School of Public Health). Project director is Mary Roary (Hopkins School of Nursing).