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

Journal of General Internal Medicine, 05/16/2012

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.

Methods

  • 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.
  • 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.
  • Change in 4–year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months.

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.

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