Counseling African Americans to Control Hypertension (CAATCH): Cluster Randomized Clinical Trial Main Effects

Study Questions:

Does a multi-level intervention improve blood pressure (BP) control among hypertensive African Americans who receive care in low-resource primary care practices?

Methods:

CAATCH (Counseling African Americans to Control Hypertension) was a cluster-randomized clinical trial conducted in 30 community health centers. Centers were randomly assigned to the intervention arm or usual care. Patients at the intervention arm sites received patient education, home BP monitoring, and monthly lifestyle counseling. Physicians in the intervention arm sites attended monthly hypertension case rounds, and received feedback on their patients’ home BP readings and chart audits. Patients and physicians at the usual care sites received printed patient education material and hypertension treatment guidelines, respectively. The primary outcome was BP control at 12 months. Secondary outcomes included mean changes in systolic and diastolic BP, which was assessed with an automated BP devise. Recruitment occurred between October 2004 and February 2009, with study follow-up through March 2011.

Results:

A total of 1,059 patients (mean age 56 years; 28% men, 59% obese, and 36% with diabetes) were enrolled. Mean attendance rate for physicians participating in the intervention sites (n = 96) was 66% for continuing medical education (CME) sessions. Fifty-three percent of patients completed all the patient education modules. Thirty-eight percent returned home BP diaries for all four visits, and 45% received 4-6 lifestyle counseling sessions. The BP control rate was similar in both groups (intervention group = 49.3% vs. usual care group = 44.5%; odds ratio [OR], 1.21; 95% confidence interval [CI], 0.90-1.63; p = 0.21). In prespecified subgroup analyses, the intervention group was associated with greater BP control in patients without diabetes (intervention group = 54.0% vs. usual care group = 44.7%; OR, 1.45; CI, 1.02-2.06); and small-sized community health centers (intervention group = 51.1% vs. usual care group = 39.6%; OR, 1.45; CI, 1.04-2.45).

Conclusions:

The investigators concluded that a practice-based multicomponent intervention was no better than usual care in improving BP control among hypertensive African Americans who received care in low-resource primary care practices.

Perspective:

This trial suggests that the barriers to improved BP control among African Americans receiving care from low-resource primary care practices are numerous and influence interventions which center in at the health care provider level. It is likely that additional efforts to improve environmental factors (i.e., access to healthy foods, and parks and recreation venues), in concert with interventions like those used in the CAATCH trial, are required to improve BP control in resource-poor communities.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension

Keywords: Follow-Up Studies, Health Food, European Continental Ancestry Group, Counseling, Systole, Cardiovascular Diseases, Education, Medical, Continuing, Obesity, Confidence Intervals, Blood Pressure Determination, Community Health Centers, Hypertension, Diabetes Mellitus


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