A three-year Johns Hopkins study led by a nurse
investigator has found that it may take a "village" to
significantly lower the blood pressure of urban
"The traditional one-on-one doctor-patient visit in a
doctor's office will simply not work," said lead author
Martha N. Hill, dean of the
School of Nursing.
"What our study suggests is that you need a whole team
socially and culturally linked to this population,
including community members as staff and a vigorous tracing
method to assure compliance with the blood pressure
While further research is needed to demonstrate the
cost-effectiveness of intense team intervention, Hill said
she suspects that it will be a savvy investment. "These men
tend to use a hospital emergency room for primary care, so
spending the relatively low costs for intervention now
should help keep these men healthier and out of expensive
hospital care later," she said.
Results of the study of 309 hypertensive
African-American men ages 21 to 54 living in inner-city
Baltimore, published in the November issue of the
American Journal of Hypertension, also dispel the
myth that underserved African-American men are hard to
include in clinical trials, Hill said. "This high-risk
population is vastly understudied and typically thought to
be hard to reach," Hill said, "but we found that the men
cared about their health and were eager to manage their
high blood pressure and to participate in the research."
High blood pressure affects one in four American
adults. Among African-Americans, it occurs more often,
begins at an earlier age and is usually more severe
compared to whites. In addition, organ damage resulting
from hypertension is higher among African-Americans. In
poor urban communities, social and economic burdens often
contribute to lower rates of treatment and control.
Hill and colleagues from the Johns Hopkins schools of
Nursing, Medicine and Public Health set out to evaluate the
effectiveness of a multidisciplinary team intervention
program that included education, behavior modification and
free hypertension medication to control blood pressure. The
team comprised a nurse practitioner, community health
workers and a physician.
Participants were randomly assigned to one of two
groups. Both groups were given education about the benefits
of controlling hypertension. One group then received a
comprehensive, individualized intervention by the health
care team. Nurse practitioner visits were scheduled every
one to three months, and all participants got free high
blood pressure medication. A community health worker
provided referrals to social services, including job
training, and assisted with locating housing. The men in
the other group received a less intensive intervention
including referrals to sources of hypertension care in the
community. Men in both groups received reminders of the
importance of blood pressure control and were evaluated at
the beginning of the intervention and at 12, 24- and
While men in both groups benefited from the
intervention, men who received the intensive intervention
had blood pressure control rates of 44 percent compared to
a 17 percent control rate at the start of the study. Among
the men receiving only education and referrals, blood
pressure control rates increased from 21 percent to 31
percent. The overall control rate for hypertensive people
nationwide is 27 percent.
Upon completion of the research, Hill's team worked
with the Men's Center, a clinic in East Baltimore, to make
sure the men in the study continue to have access to
receiving treatment to control their blood pressure.
The study was supported by the National Institute of
Nursing Research and the National Center for Research
Resources, both of the National Institutes of Health; W.A.
Baum Co.; and Merck & Co. Other authors are Cheryl R.
Dennison, Hae-Ra Han, Miyong Kim and Mary C. Roary, all
from the School of Nursing; Roger S. Blumenthal, David M.
Levine and Wendy S. Post, all from the School of Medicine;
and Lee R. Bone, R.N., from the School of Public Health.