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Study Targets Hypertension Disparity

This year, the KP Northern California Division of Research received an $11 million grant from the National Institute of Neurological Disorders and Stroke (NINDS) for a series of studies on stroke prevention in blacks and young adults, to be conducted in conjunction with the University of California, San Francisco. The first study, Shake, Rattle and Roll, seeks to close the disparity between blacks and whites in controlling high blood pressure.

In June, the study began enrolling black patients at the Oakland Medical Center with diagnosed uncontrolled high blood pressure, or hypertension. Mai N. Nguyen-Huynh, MD, MAS, of the Division of Research, is principal investigator on this study. A board-certified vascular neurologist, Dr. Nguyen-Huynh is also director of the Kaiser Permanente Primary Stroke Centers in the Diablo Service Area and an assistant professor of neurology at UCSF.

What is the goal of the Shake, Rattle and Roll study?

Kaiser Permanente Northern California raised hypertension control rates among its members from 44 percent in 2001 to more than 80 percent in 2009. While this has resulted in tremendous health benefits for our members and concurrent reductions in stroke, heart attack, and other life-threatening illnesses, a 5 percent disparity in hypertension control persists between blacks and whites. Blacks have a much higher stroke rate, and hypertension is the number one modifiable risk factor for stroke. The study’s main goal is to eliminate the disparity by figuring out the most effective, culturally appropriate methods for treating high blood pressure in blacks.

How will the study be implemented?

‘Shake, Rattle and Roll’ stands for ‘shake’ the salt habit, ‘rattle’ the intensity of our blood pressure control protocol, and ‘roll out’ best practices to the community, region, and nation. About 100 primary care physicians at the Oakland Medical Center who treat patients with uncontrolled hypertension were randomized into 1 of 3 groups: a diet and lifestyle intervention, an enhanced medication monitoring intervention, and the control group, which will continue to receive our usual high standard of care for hypertension.

Can you tell us more about how the intervention will work?

We are employing state-of-the-art methods for each. For the diet and lifestyle intervention, patients will receive up to 16 telephone coaching sessions focused on the Dietary Approaches to Stop Hypertension (DASH) diet, which has been shown in clinical trials to be effective for lowering blood pressure in blacks. The focus is on healthy eating, rather than weight loss, with an emphasis on lowering sodium intake and increasing the consumption of fruits, vegetables, whole-wheat foods, and low-fat dairy.

For the enhanced medication monitoring intervention, we have hired a registered nurse who will meet face to face with patients, to explore barriers and any difficulties participants are having with their prescribed medications and blood pressure management. A study clinical pharmacist will also be available to answer questions face to face or over the phone. The control group will receive Kaiser Permanente’s regular medical protocol for hypertension.

At the end of the study year, what do you hope to learn as far as best practices for reducing hypertension and preventing stroke?

We are trying to figure out what patients understand about their medical condition and what the perceived barriers are for blood pressure control. Medicine may not be a cure-all, and we know that it’s not just about writing prescriptions for people. Smaller studies have shown that face-to-face interactions are very helpful to increase patient awareness and knowledge about their condition and improve medication adherence. And if we learn that the telephone coaching program works, we can incorporate it as part of our health education program to promote self-care of blood pressure management through healthier eating among all our members. We are very encouraged so far: When offered the option to participate in the study, the vast majority of our members have said yes—they are willing to invest the time to receive additional resources and learn how to improve their hypertension control.

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