Abstract
ObjectivesTo 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.MethodsCluster 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.Results139 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).ConclusionThis intervention led to significant improvements in DBP and adherence to lifestyle recommendations, supporting the need for culturally appropriate hypertension care.Trial RegistrationControlled-Trials.com ISRCTN35675524
Highlights
In Western countries, people of African descent have a higher prevalence of hypertension (HTN) and HTN-related cardiovascular morbidity and mortality than people of European origin [1,2,3]
In previous studies we developed a protocol to facilitate the delivery of culturally adapted hypertension education (CAHE) and we identified provider-based barriers and enablers influencing the implementation of Culturally Adapted Hypertension Education (CAHE) by Dutch primary care practices [24,25,26,33]
Nurse-led, culturally adapted patient education appears to have a beneficial effect on DBP and adherence to lifestyle recommendations for African-Surinamese and Ghanaian patients with uncontrolled HTN when compared with usual care
Summary
In Western countries, people of African descent have a higher prevalence of hypertension (HTN) and HTN-related cardiovascular morbidity and mortality than people of European origin (white) [1,2,3]. Dutch studies reported prevalence rates of HTN of 47% among Surinamese, 55% among Ghanaians compared with 38% among whites [4,5] While these studies found no differences in HTN awareness and treatment rates among the three ethnic groups, among treated hypertensives, blood pressure (BP) control rates varied from respectively 37% for the Surinamese, 33% for the Ghanaians and 47% for the whites [5,6]. This demonstrates that there is a need to address barriers to BP control among Surinamese and Ghanaians who are treated for HTN in the Netherlands. Enhancing patient adherence to therapeutic measures is an essential first step towards reducing the observed ethnic disparities in BP control [3,7,8,9,10]
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