Abstract 186: Longer Term Effect of Lifestyle Intervention on Blood Pressure Control Among African Americans

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Abstract

Background: In Kaiser Permanente Northern California (KPNC), an integrated healthcare system with a high overall hypertension (HTN) control rate, blacks still had poorer blood pressure (BP) control than whites. The “Shake, Rattle and Roll” (SRR) trial is named for: 1) “shake” the salt habit; 2) “rattle” the intensity of current BP management; and 3) adapt and “roll” out the interventions to other communities. Successful lifestyle (LS) interventions tend to be short-lived. We evaluated the effect of LS intervention in SRR on BP control at 12 months after the trial ended.

Methods: SRR is a pragmatic cluster-randomized controlled trial conducted at Kaiser Oakland. All PCPs and their panels of black patients were randomized, stratified by panel size, to one of 3 arms: 1) usual care (UC); or 2) enhanced monitoring (EM) of KPNC BP management protocol; or 3) culturally tailored LS coaching focused on the DASH eating plan. Black patients from KPNC HTN Registry with a persistent high BP reading ≥ 140/90 qualified to be recruited into SRR. The intervention period lasted 12 months followed by 15 months of data collection with no participant contact. We assessed BP control rates using the latest follow-up BP measurements between enrollment and 27 months post-enrollment. Data on demographics and medications were collected from participants’ EMRs.

Results: We randomized 98 PCPs. There were 1,129 enrolled in UC, 346 in EM and 286 in LS. Median age was 61 years. At the end of 12 months post-intervention, BP control rates were higher in LS than in UC (73.2% vs. 60.6%, p<0.001; Table). There was no difference across arms for adherence to BP medications, change in weight, or outpatient primary care utilization.

Conclusions: Participants in LS arm continued to have better BP control than UC at 12 months after intervention ended in SRR. The sustainability of a culturally appropriate LS intervention with a focus on DASH should be studied further for implementation in adults with uncontrolled HTN.

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