As little as one home visit by a community health
worker, as part of a community/academic health center
program, may be enough to encourage someone with high blood
pressure to take measures to lower it, a Johns Hopkins
study demonstrates.
For their study, Johns Hopkins physicians, nurses and
public health workers joined forces with the community
health advisory board of Sandtown-Winchester, a
72-square-block neighborhood of more than 10,000, mostly
African-American residents in West Baltimore, with the goal
of helping residents lower their blood pressure. High blood
pressure-related heart disease death rates in this
community are among the highest in the United States. In
1991, 35 percent of residents were hypertensive, and only
15 percent had controlled blood pressure.
Community-based health workers trained by the Johns
Hopkins team identified people with hypertension, then
visited those patients at home up to five times over a
40-month period to educate them about blood pressure
control. Three years after the initial visit, the
residents' average blood pressure reading had dropped by
4.5 mmHg systolic (the upper number) and 4 mmHg diastolic
(the lower number). In addition, the percentage of
individuals who were controlling their blood pressure
doubled. Study results are published in the summer issue of
the journal Ethnicity & Disease.
"We've had excellent treatment for blood pressure for
over 30 years," said David M. Levine, lead author of the
paper and a professor of medicine, public health and
nursing at Johns Hopkins. "If patients are able to come in
and remain in medical care, adhering to treatment
recommendations, they do well. But most urban residents are
not in that group, especially if they live in high-risk
communities. Academic health centers can reach out to these
communities, but it's best to do so in a partnership
approach."
In setting up the program, the Johns Hopkins team
trained community-based health workers for three months in
blood pressure management and monitoring, education and
counseling, social support and community outreach.
The initial community survey found 817 people with
hypertension. Eighty-six percent knew they had high blood
pressure; 14 percent were newly detected during the survey.
Researchers randomly assigned residents of each census
block to either one home visit or five. Of the 817, 789
agreed to participate in the study, with 387 assigned to
five visits and 402 to one visit.
Forty months after enrollment, researchers were able
to reinterview 471 participants: 53 had died, five were
incarcerated, 23 were too sick to be interviewed, and 191
had moved, leaving no follow-up address. Twenty-two
participants could not be reached at home, and 24 refused
to be interviewed.
There was no statistically significant difference in
lowered blood pressures among participants in the one- and
five-visit groups. The percentage of participants with
controlled blood pressure increased from 16 to 36 in the
five-visit group and from 18 to 34 in the one-visit
group.
Levine acknowledged the challenges in setting up such
programs, including enlisting support from community
leaders and local health providers.
"We wouldn't have had the access to this community
that we did without the participation of leaders from their
health advisory board," he said. "They were tremendously
instrumental in getting us access to households, letting us
disseminate our messages and helping us build trust."
Also key in a successful partnership, Levine said, is
maintaining relationships with the community. The Johns
Hopkins team is continuing to work with Sandtown-Winchester
residents on blood pressure control and, based on the
partnership, has started health programs to address
substance abuse, obesity and arthritis. The team also
worked closely with a free health clinic for residents that
had been established.
The study was funded by the National Heart, Lung and
Blood Institute. Co-authors were Lee R. Bone, Martha N.
Hill, Rebecca Stallings, Allan C. Gelber, Anne Barker,
Elder C. Harris; Scott L. Zeger, Kaytura L. Felix-Aaron and
Jeanne M. Clark.
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