Shake, Rattle and Roll

在美国，黑人高血压（HTN）患病率较高，缺血性心脏病的发病率较高。 与白人相比。不到50%的高血压成年人血压得到控制。种族 在接受治疗和成功治疗的比例方面存在差异，特别是 白色之间在北方加州的Kaiser Permanente（KPNC），所有成员 尽管黑人患者获得类似的医疗保健，但患有缺血性卒中和HTN的黑人患者在 卒中后6个月，与其他种族相比，尽管医疗保健利用率相同，抗高血压 处方和依从性。有人认为，控制血压和生活方式的难度更大， 差异可以解释这种差异。 这项务实研究的目的是提高黑人HTN控制率，减少种族差异， HTN控制。为了实现这一目标，我们建议在主要研究领域进行一项群集随机对照试验。 护理提供者（PCP）水平，包括KPNC东湾服务区内的191名PCP， HTN登记中有45，000名患者，其中约15，000名是黑人。我们会随机抽取所有的PCP 三组患者接受1）常规护理;或2）文化定制的饮食和生活方式 指导;或3）加强BP管理协议与药物治疗。 “摇、摇、滚”试验的命名是：1）“摇”盐的习惯; 2）“摇”电流的强度 BP管理;以及3）设计干预措施，目标是能够适应和“推出”它们， 管理式医疗系统之外的社区诊所。 主要研究问题：饮食和生活方式指导的一级预防干预是否 或强化药物治疗方案在提高HTN控制率方面比常规治疗更有效 从而减少黑人和白色之间的差异。 主要目的：通过实施任何一种干预措施，我们将缩小高血压控制率的差距 在研究入组后1年，黑人和白人之间的差异为4%。 假设：在患有HTN的黑人中，饮食/生活方式指导干预或强化BP管理 与常规护理相比，该方案将导致HTN控制率增加。 主要结局：研究入组后1年血压持续控制的患者比例。

In the U.S., blacks have a higher prevalence of hypertension (HTN) and a higher Incidence of ischemic Stroke compared to whites. Less than 50% of adults with hypertension have controlled BP. Racial disparities exist with regard to the proportions of those who are treated and treated successfully, especially between black and white. In Kaiser Permanente Northern California (KPNC), a setting where all members have similar access to healthcare, black patients with ischemic stroke and HTN still had poorer BP control at 6 months post-stroke when compared to other races despite equal healthcare utilization, antihypertensive prescription and adherence. It has been suggested that greater difficulty in controlling BP and lifestyle differences may account for this difference. The goal of this pragmatic study is to improve HTN control rate in blacks and to reduce racial disparity in HTN control. To accomplish this, we propose to perform a cluster randomized controlled trial at the primary care provider (PCP) level and including 191 PCPs within KPNC East Bay Service Area with more than 45,000 patients in the HTN registry of which approximately 15,000 are black. We will randomize all PCP patient panels to a three-arm trial to receiving either 1) usual care; or 2) culturally tailored diet and lifestyle coaching; or 3) an intensified BP management protocol with pharmacotherapy. The "Shake, Rattle and Roll" trial is named for: 1) "shake" the salt habit; 2) "rattle" the intensity of current BP management; and 3) design the interventions with the goal of being able to adapt and "roll" them out to community clinics outside of a managed care system. Primary research question: whether a primary prevention intervention of either diet and lifestyle coaching or an intensive pharmacotherapy protocol is more effective than usual care in improving rates of HTN control in blacks and thereby reducing disparities between black and white. Primary aim: By implementing either intervention, we will reduce the disparity in hypertension control rates between blacks and whites by 4% at 1 year post-study enrollment. Hypothesis: Among blacks with HTN, a diet/lifestyle coaching intervention or an intensified BP management protocol will result in an increase in HTN control rate compared to usual care. Primary outcome: the proportion of patients with sustained BP control at 1 year post-study enrollment.