Abstract P3054: A Cultural Dance Program Proves Efficacious for Hypertension Control: A Randomized Controlled Trial

Abstract

Minority populations are at high risk for hypertension (HTN) and its sequellae. Native Hawaiians (NH) are 70% more likely to have HTN; 4 times more likely to have coronary heart disease (CHD) or stroke than Whites. Hula, the traditional dance of NH, offers the promise of a culturally responsive strategy to improve HTN control. We conducted a randomized clinical trial (RCT) with a waitlist control to test the impact of a hula-based intervention on systolic blood pressure (SBP) in 263 NH with uncontrolled HTN (SBP ≥ 140 mmHg or ≥ 130 mmHg if diabetes) but no prior CHD or stroke. All participants received HTN education (e.g., diet, exercise, medication) during 3 1-hr sessions over 2 weeks, and were then randomly assigned to hula-based intervention (HI; n = 131) or waitlist control ( n = 132). The HI received 6 months of hula (2 1hr sessions/week x 3 months, then 1 lesson/month x 3 months with self-directed practice), with group activities to reinforce HTN education and healthy behaviors. Waitlist control received the initial HTN education and then offered hula after the study. Assessments were done at 0-, 3- and 6-month, with 12-month for HI only. We used standard approaches to assess clinical and other measures. Baseline characteristics were balanced between the groups, except for weight. Adjusting for weight and baseline SBP in intent-to-treat analysis, HI achieved significant reductions ( p < .05) in SBP (-15.3 mmHg; SE = 1.6) and DBP (-6.4 mmHg; SE = 1.0) compared to controls (-11.8 mmHg, SE = 1.7; -2.6 mmHg, SE = 1.0, respectively). From 6 to 12 months, HI maintained their SBP (mean change: 1.47 mmHg, SE = 1.26; p = .16) and DBP (mean change: 0.82 mmHg, SE = 0.81; p = .63) improvements at 12 months. HI were more likely to achieve SBP reduction ≥ 10 mmHg than control, 60% vs 48% ( p = .03), respectively. Retention was similar for both groups at 6 (83%; 218 of 263) and 12 (77%; 101 of 131) month follow-up. A hula-based intervention improved HTN control in NH with elevated SBP. Notably, our study demonstrates the feasibility of recruiting and retaining a high-risk minority population for a RCT. With strong implications for other indigenous populations, to our knowledge, these findings represent one of the few rigorously performed examinations of an indigenous practice leveraged for health promotion.