Nursing Research: A Community-Based Intervention Improved Blood Pressure Control for Inner-City Black Men

Chronic high blood pressure (HBP) can cause damage to certain organs, particularly the heart and the kidneys. In the United States, black men tend to have a higher prevalence and an earlier onset of HBP than white men, as well as lower rates of treatment and higher rates of organ damage. Researchers enrolled 309 inner-city black men diagnosed with HBP in a 5-year community-based intervention to improve blood pressure control. The average age of the men at baseline was 41 years, 60% had a high school diploma, 27% were employed, and 64% reported a history of incarceration.

Half of the men received a less intensive program involving education about reducing HBP, a referral to community HBP care sources, and annual health evaluations. The other half received a more intensive program of HBP treatment from a healthcare team consisting of a nurse practitioner (NP), a community health worker (CHW), and a physician. The NP scheduled regular visits for HBP check-ups, offered education on healthy diet and lifestyle behaviors, provided free medications, and adjusted the medication dosages according to established protocols. The CHW offered referrals to social services, job training, and housing. The physician provided consultation and participated in case discussions. Study retention was high, with follow-up rates of 89% after accounting for men who were incarcerated, had moved away, or had died.

At 5 years, average systolic and diastolic blood pressures decreased in both groups. Also, the onset and progression of left ventricular hypertrophy, a sign of heart damage, was lower in the more intensive group compared with the less intensive group. No differences in signs of kidney function were noted between the groups. At the end of the study, men in both groups reported declines in smoking and in eating salty foods, while more were employed and had health insurance. Over the course of the study, 17% of the men died. The most frequent causes of death were drug or alcohol use, cardiovascular disease, and AIDS. Improved access to healthcare, preventive services, and substance abuse treatment may help to reduce the high rate of mortality seen in this at-risk population.

A Community-Based Intervention Improved Blood Pressure Control for Inner-City Black Men
Dennison CR, Post WS, Kim MT, et al. Underserved urban African American men: hypertension trial outcomes and mortality during 5 years. American Journal of Hypertension. 2007;20:164-171.