Journal article
Equitable Care for Hypertension: Blood Pressure and Patient-Reported Outcomes of the RICH LIFE Cluster Randomized Trial
Circulation (New York, N.Y.), v 150(3), pp 230-242
16 Jul 2024
PMID: 39008556
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Disparities in hypertension control are well documented but underaddressed.
RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) was a 2-arm, cluster randomized trial comparing the effect on blood pressure (BP) control (systolic BP ≤140 mm Hg, diastolic BP ≤90 mm Hg), patient activation, and disparities in BP control of 2 multilevel interventions, standard of care plus (SCP) and collaborative care/stepped care (CC/SC). SCP included BP measurement standardization, audit and feedback, and equity-leadership training. CC/SC added roles to address social or medical needs. Primary outcomes were BP control and patient activation at 12 months. Generalized estimating equations and mixed-effects regression models with fixed effects of time, intervention, and their interaction compared change in outcomes at 12 months from baseline.
A total of 1820 adults with uncontrolled BP and ≥1 other risk factors enrolled in the study. Their mean age was 60.3 years, and baseline BP was 152.3/85.5 mm Hg; 59.4% were women; 57.4% were Black, 33.2% were White, and 9.4% were Hispanic; 74% had hyperlipidemia; and 45.1% had type 2 diabetes. CC/SC did not improve BP control rates more than SCP. Both groups achieved statistically and clinically significant BP control rates at 12 months (CC/SC: 57.3% [95% CI, 52.7%-62.0%]; SCP: 56.7% [95% CI, 51.9%-61.5%]). Pairwise comparisons between racial and ethnic groups showed overall no significant differences in BP control at 12 months. Patients with coronary heart disease showed greater achievement of BP control in CC/SC than in SCP (64.0% [95% CI, 54.1%-73.9%] versus 50.8% [95% CI, 42.6%-59.0%];
=0.04), as did patients in rural areas (67.3% [95% CI, 49.8%-84.8%] versus 47.8% [95% CI, 32.4%-63.2%];
=0.01). Individuals in both arms experienced statistically and clinically significant reductions in mean systolic BP (CC/SC: -13.8 mm Hg [95% CI, -15.2 to -12.5]; SCP: -14.6 mm Hg [95% CI, -15.9 to -13.2]) and diastolic BP (CC/SC: -6.9 mm Hg [95% CI, -7.8 to -6.1]; SCP: -5.5 mm Hg [95% CI, -6.4 to -4.6]) over time. The difference in diastolic BP reduction between CC/SC and SCP over time was statistically significant (-1.4 mm Hg [95% CI, -2.6 to -0.2). Patient activation did not differ between arms. CC/SC showed greater improvements in patient ratings of chronic illness care (Patient Assessment of Chronic Illness Care score) over 12 months (0.12 [95% CI, 0.02-0.22]).
Adding a collaborative care team to enhanced standard of care did not improve BP control but did improve patient ratings of chronic illness care.
Metrics
Details
- Title
- Equitable Care for Hypertension: Blood Pressure and Patient-Reported Outcomes of the RICH LIFE Cluster Randomized Trial
- Creators
- RICH LIFE Project Investigators (Collaboration)Lisa A Cooper - Department of Epidemiology (L.A.C., K.A.C., D.C.C., N.-Y.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MDJill A Marsteller - Department of Health Policy and Management (L.A.C., C.R.D.H., J.A.M., L.L.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MDKathryn A Carson - Johns Hopkins UniversityKatherine B Dietz - Johns Hopkins UniversityRomsai T Boonyasai - Agency for Healthcare Research and QualityCarmen Alvarez - University of PennsylvaniaDeidra C Crews - Johns Hopkins MedicineCheryl R Dennison Himmelfarb - Johns Hopkins UniversityChidinma A Ibe - Johns Hopkins UniversityLisa Lubomski - Johns Hopkins UniversityEdgar R Miller, 3rd - Johns Hopkins MedicineNae-Yuh Wang - Johns Hopkins MedicineGideon D Avornu - Johns Hopkins MedicineDeven Brown - Johns Hopkins UniversityDebra Hickman - Johns Hopkins UniversityMichelle Simmons - Johns Hopkins UniversityAriella Apfel Stein - Johns Hopkins UniversityHsin-Chieh Yeh - Johns Hopkins MedicineMariana Lazo - Drexel University, Community Health and Prevention
- Publication Details
- Circulation (New York, N.Y.), v 150(3), pp 230-242
- Number of pages
- 13
- Grant note
- UH3 HL130688 / NHLBI NIH HHS UH2 HL130688 / NHLBI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Community Health and Prevention
- Web of Science ID
- WOS:001272371500006
- Scopus ID
- 2-s2.0-85198941992
- Other Identifier
- 991022019813104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Peripheral Vascular Disease