Hypertension care and control in underserved urban African American men: behavioral and physiologic outcomes at 36 months

sion in low socioeconomic urban populations achieve poor rates of hypertension control and suffer early from its complications. Methods: In a randomized clinical trial with 309 hy-pertensive urban African American men aged 21 to 54 years, we evaluated the effectiveness of a more intensive comprehensive educational-behavioral-pharmacologic in-tervention by a nurse practitioner-community health work-er-physician (NP/CHW/MD) team and a less intensive education and referral intervention in controlling blood pressure (BP) and minimizing progression of left ventric-ular hypertrophy (LVH) and renal insufficiency. Changes in BP, left ventricular mass (LVM), and serum creatinine from baseline to 36 months were compared between groups. Results: At 36 months, the mean systolic BP/diastolic BP change from baseline was 7.5/10.1 mm Hg for the more intensive group and 3.4/3.7 mm Hg for the less intensive group (P .001 and.005 for between-group differences in systolic BP and diastolic BP, respectively). The proportion of men with controlled BP (140/90 mm Hg) was 44 % in the more intensive group and 31 % in the less intensive group (P .045). The LVM was signifi-cantly lower in the more intensive group than in the less intensive group (more intensive, 274 g; less intensive, 311 g; P .004). There was a trend toward slowing of the progression of renal insufficiency (incidence of 50 % in-crease in serum creatinine) in the more intensive group compared to the less intensive group (more intensive, 5.2%; less intensive, 8.0%; P .08). Conclusions: During 36 months, the more intensive intervention led to a lower BP and decreased progression of LVH in a sample of hypertensive young African Amer-ican men. Am J Hypertens 2003;16:906–913 © 200