Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial

Erik J A J Beune; Eric P Moll van Charante; Leo Beem; Jacob Mohrs; Charles O Agyemang; Gbenga Ogedegbe; Joke A Haafkens

doi:10.1371/journal.pone.0090103

Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial

PLoS One. 2014 Mar 5;9(3):e90103. doi: 10.1371/journal.pone.0090103. eCollection 2014.

Authors

Erik J A J Beune¹, Eric P Moll van Charante², Leo Beem², Jacob Mohrs², Charles O Agyemang³, Gbenga Ogedegbe⁴, Joke A Haafkens²

Affiliations

¹ Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Public Health, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
² Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Public Health, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.

Abstract

Objectives: To evaluate the effect of a practice-based, culturally appropriate patient education intervention on blood pressure (BP) and treatment adherence among patients of African origin with uncontrolled hypertension.

Methods: Cluster randomised trial involving four Dutch primary care centres and 146 patients (intervention n=75, control n=71), who met the following inclusion criteria: self-identified Surinamese or Ghanaian; ≥ 20 years; treated for hypertension; SBP ≥ 140 mmHg. All patients received usual hypertension care. The intervention-group was also offered three nurse-led, culturally appropriate hypertension education sessions. BP was assessed with Omron 705-IT and treatment adherence with lifestyle- and medication adherence scales.

Results: 139 patients (95%) completed the study (intervention n=71, control n=68). Baseline characteristics were largely similar for both groups. At six months, we observed a SBP reduction of ≥ 10 mmHg -primary outcome- in 48% of the intervention group and 43% of the control group. When adjusted for pre-specified covariates age, sex, hypertension duration, education, baseline measurement and clustering effect, the between-group difference was not significant (OR; 0.42; 95% CI: 0.11 to 1.54; P=0.19). At six months, the mean SBP/DBD had dropped by 10/5.7 (SD 14.3/9.2)mmHg in the intervention group and by 6.3/1.7 (SD 13.4/8.6)mmHg in the control group. After adjustment, between-group differences in SBP and DBP reduction were -1.69 mmHg (95% CI: -6.01 to 2.62, P=0.44) and -3.01 mmHg (-5.73 to -0.30, P=0.03) in favour of the intervention group. Mean scores for adherence to lifestyle recommendations increased in the intervention group, but decreased in the control group. Mean medication adherence scores improved slightly in both groups. After adjustment, the between-group difference for adherence to lifestyle recommendations was 0.34 (0.12 to 0.55; P=0.003). For medication adherence it was -0.09 (-0.65 to 0.46; P=0.74).

Conclusion: This intervention led to significant improvements in DBP and adherence to lifestyle recommendations, supporting the need for culturally appropriate hypertension care.

Trial registration: Controlled-Trials.com ISRCTN35675524.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antihypertensive Agents / therapeutic use*
Blood Pressure
Cluster Analysis
Culturally Competent Care*
Female
Ghana / ethnology
Humans
Hypertension / drug therapy*
Hypertension / physiopathology
Male
Medication Adherence
Middle Aged
Netherlands
Patient Education as Topic
Risk Reduction Behavior
Suriname / ethnology
Treatment Outcome

Substances

Antihypertensive Agents

Associated data

ISRCTN/ISRCTN35675524

Grants and funding

This study was funded by ZonMw, the Netherlands organisation for health research and development (grant no. 122000008). ZonMw-website: http://www.zonmw.nl/en/. The study sponsor funded the study and carried out annual and mid-term reviews of the study's progress. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.