Improving Hypertension Control in the Inner City
Condition: Cardiovascular Diseases; Heart Diseases; Hypertension
MeSH terms: Hypertension; Cardiovascular Diseases; Heart Diseases
Study type: Observational

Summary: 
      To conduct a community based education program using existing resources to improve
      hypertension control in the inner city through multiple interventions.
    

Detailed description: 
      BACKGROUND:

      The study was in response to a demonstration and education initiative, "Improving
      Hypertensive Care for Inner City Minorities", which was reviewed and approved by the Clinical
      Applications and Prevention Advisory Committee in April 1992 and by the National Heart, Lung,
      and Blood Advisory Council in May 1992. The Request for Applications was released in October
      1992.

      DESIGN NARRATIVE:

      The program consisted of a community wide education program, an intensive intervention
      directed toward individuals with hypertension, and an intervention for health care providers.
      The program was developed by a coalition of community organizations. In the community wide
      educational intervention, a baseline household survey was used to identify barriers to
      hypertension control in the community. This information was used in planning the intervention
      strategies, targeting the educational efforts, and developing the educational messages.
      Existing community organizations (churches, local media, neighborhood organizations, etc)
      were used to implement educational efforts over a three year period. Program success was
      evaluated by comparing findings on a follow-up household survey with those at baseline. Level
      of blood pressure control was the primary outcome measure. For the intensive educational
      program for hypertensives, the investigators developed a hypertension registry of individuals
      with high blood pressure who were identified from a number of community sources. All
      individuals on the registry receive educational material through the mail. Individuals with
      uncontrolled hypertension were randomized to receive the usual mailed educational materials
      or a more intensive personalized 12 month intervention using lay health advisors.

      In the evaluation, the investigators compared blood pressure control morbidity and mortality
      between these two intervention arms of the registry. The innovative educational approach to
      health care providers utilized the existing community-based Area Health Education Center
      (AHEC) network to communicate community-determined hypertension control needs and
      community-determined hypertension control strategies to health care providers and students.
      The research was designed to elucidate community factors in the inner city that dictated
      strategies necessary for success in a variety inner city environments. Specifically, the
      investigators examined the effect of community size and level of community stress (as
      indicated by poverty, crime, etc.) on program development and outcome. To do this, they
      implemented the program in one city-wide community (Milwaukee) and in three well defined,
      homogeneous inner city neighborhoods of Chicago which had differing levels of community
      stress indicators. They evaluated the effect of size and community stress levels on the
      program strategies and successes.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        African-Americans with or without hypertension