Shake, Rattle and Roll

在美国，黑人有更高的高血压(HTN)患病率和更高的缺血率 中风与白人相比。只有不到50%的成年高血压患者控制了血压。种族 在接受治疗和治疗成功的人的比例方面存在差异，特别是 在黑白之间。在Kaiser Permanente North California(KPNC)中，所有成员 有类似的获得医疗保健的机会，患有缺血性中风和HTN的黑人患者在 中风后6个月，尽管医疗保健利用率相同，但与其他种族相比，抗高血压 处方和依从性。有人建议，控制BP和生活方式的难度更大 差异可能是造成这种差异的原因。 这项务实研究的目标是提高黑人的HTN控制率，减少 HTN控制中心。为了实现这一目标，我们建议在初选阶段进行一项整群随机对照试验 护理提供者(PCP)级别，包括KPNC东湾服务区内的191个PCP，超过 HTN登记处有45,000名患者，其中约15,000名是黑人。我们将随机化所有的五氯苯酚 患者参加三臂试验，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)加强药物治疗的BP管理方案。 “摇摆摇摆”试验的名字是：1)“摇”盐习惯；2)“搅动”水流的强度。 BP管理；以及3)设计干预措施，以使其能够适应并“推广”到 管理医疗系统之外的社区诊所。 主要研究问题：饮食和生活方式训练是否是一级预防干预 或者强化药物治疗方案在提高HTN控制率方面比常规护理更有效 并因此缩小了黑人和白人之间的差距。 主要目标：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。 黑人和白人之间的差距在一年后入学时增加了4%。 假设：在患有HTN的黑人中，进行饮食/生活方式指导干预或强化BP管理 方案将导致HTN控制率比通常护理增加。 主要结果：研究后1年患者持续血压控制的比例。

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.