African Americans have historically had uncontrolled blood pressure (among some of the highest rates in the world at 40% of the black population). Hypertension could lead to serious health issues, such as stroke, aneurysms, kidney disease, or metabolic syndrome. Doctors who have undergone interventional cardiology training understand the serious implications of high blood pressure; if left unmonitored and unattended, it could lead to a coronary heart disease that requires catheter-based treatment of the heart.
These issues have sparked a myriad of hopeful preventative programs geared towards controlling the issue. The “Check. Change. Control” program, for example, has helped thousands of African Americans better manage high blood pressure by offering monitoring kits, clubs, and classes.
Now, a year after launching the “Shake, Rattle, and Roll,” a lifestyle coaching program at Kaiser Permanente in Oakland, blood pressure control rates among African Americans with hypertension increased from 62%with usual care to 69%.
Through the program, doctors taught patients how to make better dietary choices. The participants nixed their prior eating habits and made all food preparations and selections according to eating plan outlined by American Heart Association’s Dietary Approaches to Stop Hypertension (DASH).
Prior to the start of the SRR program, Kaiser Permanente had already done a fairly good job of implementing a hypertension program that worked well. By 2012, blood pressure control was decent, and just above par with the national average. Still, the hospital’s black population continued to lag behind whites.
“Even with equal utilization and access to care, we continued to see this clear disparity in blacks vs. whites,” Dr. Mai Nguyen-Huynh told MDedge.com.
The Shake, Rattle, and Roll study was started to analyze the effects a healthy lifestyle would have on African Americans. It consisted of three parts: participants focused on “shaking” the salt habit, “rattling” blood pressure medications, and the hospital would focus on “rolling” results in clinical practices. The study had 1,600 patients, and results were collected over the course of a year. Seventy percent of participants were women.
Through the study, patients volunteered for advanced monitoring and were subject to a urine sodium test at any point during the study. Patients had in-person counseling to identify pressure points and areas of opportunity, consistent blood pressure checks, intensified pharmacotherapy, and spironolactone for patients struggling to control hypertension despite being on various controlled medications. The exercise was also incorporated into the program, as weight loss could help decrease blood pressure and a new study has even linked weight to socioeconomic status. Each patient also had access to 16 phone sessions and bi-monthly group sessions. Additionally, a detailed workbook spanned eight sessions and helped patients keep track of their goals.
Despite the program’s success, it’s been difficult to pinpoint exactly where the improvements have derived from. There was no change in compliance with medication, nor was there a change in salt intake. Outpatient primary care also remained the same, and there weren’t any significant weight changes among the group.
Dr. Nguyen-Huynhn believes that success may be attributed to the execution of the program. In today’s tech culture, it’s possible that participants took a liking to the virtual-based assistance, where they could call in for help and monitor their own progress with the proper tools. Kaiser continues to analyze the data to better pinpoint exactly what made the program so successful among the African American patients.