Clinical trial NCT01070056: Practice-based Trial of Blood Pressure Control in African Americans
Official title: Practice-based Trial of Blood Pressure Control in African Americans
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Hypertension
Physical Activity
Diet
Medication Adherence
Keywords: Blood Pressure
Lifestyle Changes
African American
Lead sponsor: NYU Langone Health
Sponsor class: OTHER
Collaborators: name: Columbia University
name: Hebrew Home at Riverdale
name: New York City Health and Hospitals Corporation
First posted: 2010-02-17
Enrollment: 194
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Poorly controlled hypertension (HTN) remains one of the most significant public health problems in the United States, in terms of morbidity, mortality, and economic burden. Despite compelling evidence supporting the beneficial effects of therapeutic lifestyle changes (TLC) on blood pressure (BP) reduction, their effectiveness remains untested in primary care practices, especially among minority patients who share a greater burden of HTN-related outcomes including chronic kidney disease, stroke and heart failure. This randomized controlled trial offers a unique opportunity to address this gap in the literature. Among 200 hypertensive African-Americans who receive care in community- based primary care practices, we will test the effectiveness of a culturally-tailored comprehensive therapeutic lifestyle intervention, delivered through group-based counseling and motivational interviewing (MINT-TLC) vs. Usual Care (UC). MINT-TLC is designed to help patients make appropriate TLC and develop skills to maintain these changes long-term. Patients in the MINT-TLC group will attend weekly group classes focused on TLC for 12 weeks (intensive phase); followed by individual motivational interviewing (MINT) sessions for 3 months (maintenance phase). Trained research personnel will deliver MINT-TLC with appropriate treatment fidelity procedures. Patients in the UC condition will receive a single individual counseling session on TLC and print versions of the intervention materials. The primary outcome is within-patient change in both systolic and diastolic blood pressure from baseline to 6 months. Secondary outcomes are levels of targeted therapeutic lifestyle behaviors; and proportion of patients with adequate blood pressure control at 6 months

Detailed description: We will test the effectiveness of a primary care practice-based comprehensive therapeutic lifestyle intervention, delivered through group-based counseling and motivational interviewing (MINT-TLC) in a two-arm, randomized controlled trial (RCT) in 200 low-income, poorly controlled hypertensive African-American patients. MINT is a directive, participant-centered, counseling approach for initiating and maintaining behavior change that has proven effective in improving adherence to various health behaviors. We hypothesize that among African Americans with poorly controlled hypertension (HTN), those randomized to TLC group, compared to those randomized to UC, will exhibit a greater reduction in systolic and diastolic blood pressure (BP); greater levels of physical activity; percent change in weight; increased intake of fruits and vegetables; and reduced 24-hour urinary sodium excretion at 6 months.The primary outcome is within-patient change in systolic (SBP) and diastolic (DBP) from baseline to 6 months. The secondary outcomes are the levels of physical activity, percent change in weight, dietary intake of fruits and vegetables, 24-hour urinary sodium excretion and BP control rates at 6 months. Blood pressure will be assessed with a well-validated automated digital BP monitor (BPTru), following American Heart Association guidelines. Therapeutic lifestyle behaviors will be assessed with validated self-report measures: Dietary intake will be assessed with the NCI's fruit/vegetable and fat brief dietary assessment questionnaires; and physical activity will be assessed with the Nurses Health Study and Health Professionals Study's physical activity questionnaire. Percent weight loss will be estimated from the difference in weight between baseline and 6 months, while 24-hour urinary sodium excretion will be used to estimate dietary sodium intake. Patients are categorized as having controlled BP if their average BP that fulfills the Seventh Joint National Committee on Detection, Evaluation and Treatment of Hypertension (JNC-7) criteria of SBP \< 130 and DBP \< 80 mmHg (patients with diabetes or chronic kidney disease); or SBP \< 140 and DBP \< 90 mmHg (for all other patients). Regardless of group assignments, all outcomes data will be assessed at baseline, 3 months, and 6 months.

Eligibility criteria: Inclusion Criteria:

* Age 18 years or older
* Receiving care within the NYU Ambulatory Care Network for at least one year.
* Patient must have uncontrolled HTN defined as an average SBP≥140 mmHg or DBP≥90 mmHg (SBP≥130 mmHg or DBP≥80 mmHg for patients with diabetes or chronic kidney disease) on at least two previous visits in the past year
* English speaking
* Self-identify as Black, or African American;
* Permission by patient's physician to participate in the study.
* CARE-DIAG score \< 6 (participants age 60 and older only)

Exclusion Criteria:

* Being deemed unable to comply with the study protocol (either self-selected or by indicating during screening that s/he could not complete all requested tasks including attend intervention classes if he/she were to be randomized to the intervention group).
* Participation in other clinical trials.
* Diagnosis of cognitive dysfunction or significant psychiatric comorbidity (as indicated in medical record).
* Blood pressure reading ≥ 180/110 at initial screening/baseline visit
* Pregnant

Primary outcomes:
measure: The primary outcome is within-patient change in systolic (SBP) and diastolic (DBP) from baseline to 6 months.
timeFrame: 6 months
Secondary outcomes:
measure: The secondary outcomes are the levels of physical activity, percent change in weight, dietary intake of fruits and vegetables, 24-hour urinary sodium excretion and BP control rates at 6 months.
timeFrame: 6 months
Other outcomes:
Locations:
city: Brooklyn
country: United States
facility: Woodhull Medical & Mental Health Center
state: New York
city: New York
country: United States
facility: Governeur Hospital
state: New York
city: New York
country: United States
facility: Bellevue Hospital Center
state: New York
city: New York
country: United States
facility: Lincoln Hospital and Harlem Hospital
state: New York
Study officials:
affiliation: NYU Langone Health
name: Gbenga G Ogedegbe, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ogunlade AO, Williams SK, Joseph J, Onakomaiya DO, Eimicke JP, Teresi JA, Williams O, Ogedegbe G, Spruill TM. Prevalence and correlates of depression among black and Latino stroke survivors with uncontrolled hypertension: a cross-sectional study. BMJ Open. 2020 Dec 8;10(12):e040461. doi: 10.1136/bmjopen-2020-040461.
citation: Schoenthaler A, Luerassi L, Silver S, Odedosu T, Kong J, Ravenell J, Teresi JA, Ogedegbe G. Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks. Am J Hypertens. 2016 Feb;29(2):280-7. doi: 10.1093/ajh/hpv100. Epub 2015 Jul 1.
citation: Schoenthaler A, Luerassi L, Teresi JA, Silver S, Kong J, Odedosu T, Trilling S, Errico A, Uvwo O, Sebek K, Adekoya A, Ogedegbe G. A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial. Trials. 2011 Dec 22;12:265. doi: 10.1186/1745-6215-12-265.