Church-based lifestyle intervention reduces BP in black patients

According to the results of the FAITH study, a community-based lifestyle intervention in churches has resulted in a greater reduction in systolic BP than a control intervention.

"African Americans have a much heavier burden of hypertension and heart disease, and our results show that people with uncontrolled hypertension can indeed better manage their blood pressure through programs administered in places of worship ", Gbenga Ogedegbe, MD, MPH, FACP, Dr. Adolph and Margaret Berger Professor of Population Health and Medicine, Head of Health & Behavior Division and Director of the Center for Healthful Behavior Change at the NYU School of Medicine and Associate Vice Chancellor of Academic Planning for the NYU Global Network Office of Global Programs, said in a press release. "Vulnerable populations often have reduced access to primary care. We need to reduce racial disparities in hypertension-related outcomes between blacks and whites. In addition, we hope that clergy and church leaders will take note of our findings and replicate these interventions in their churches. "

For the FAITH study, researchers analyzed 373 black participants with hypertension (mean age: 64 years, 76% women) in 32 New York churches. The churches were divided into eight cohorts of four churches each, and each church was randomly assigned to its patients to receive a therapeutic lifestyle change intervention as well as motivational interviews or education to the health only. In each cohort of four churches, two were assigned to the therapeutic lifestyle change intervention and two were assigned to health education.

"The principle of this study is twofold," said Ogedegbe Cardiology today. "First, African Americans have an excessively high blood pressure and its associated complications, such as stroke and chronic kidney failure. Second, they have more difficult access to care and, as such, may not benefit from practice-based lifestyle interventions that have been proven to reduce their ability to care. high blood pressure ".

Change of therapeutic lifestyle

The intervention to change the therapeutic lifestyle consisted of 11 weekly 90-minute group sessions focused on adopting healthy lifestyle behaviors, meal planning strategies, stress management counseling, drug adherence, setting structured goals and healthy food tastings. Participants in this intervention were asked to keep a diary of their food and activities. Prayer items, scriptures, and faith-based and health-related talking points were included. Following these sessions, three monthly sessions of motivational individual interviews were organized to help participants focus on problem solving and maintaining lifestyle changes. The control group of health education received a session on lifestyle-related hypertension management and medication management, during which patients received a booklet of NIH on PA, as well as 10 information sessions on various topics related to health.

All patients had uncontrolled hypertension, defined as BP of at least 140/90 mmHg or, in those with diabetes or chronic renal failure, a BP of at least 130 / 80 mm Hg. The mean starting PA was 153/87 mm Hg.

The main result was a PA change at 6 months. The secondary result was the control of blood pressure at 9 months.

Compared to the control group, the therapeutic lifestyle change group showed a greater reduction in systolic BP at 6 months (5.79 mm Hg; P = 0.029), according to the researchers.

At 9 months, the effect of treatment was still present but less important (5.21 mm Hg; P = .068), wrote Ogedegbe and his colleagues.

"The most important points to remember are that healthy lifestyle behavior programs can be implemented safely in denominational contexts, and that they can be implemented by lay members and from Church and do not really need a health professional, "said Ogedegbe Cardiology today.

Differences between groups in the reduction of diastolic blood pressure (0.41 mm Hg) and mean arterial pressure (2.24 mm Hg) were not significant at 6 months, the researchers wrote.

The control of BP at 9 months was numerically but not significantly higher in the lifestyle change group (57% vs. 48.8%, OR = 1.43, 95% CI, 0.9-2 , 28), according to the researchers.

"There are already many blood pressure screening programs. What is needed now is to incorporate group counseling on life behavior counseling into these programs, "said Ogedegbe. Cardiology today. "The findings of this study have now provided policymakers with the information they need to disseminate and create funding policies for similar programs in denominational contexts."

Modest effect

In a related editorial, Jeremy B. Sussman, MD, MS, and Michele Heisler, MD, MPA, of the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation of the University of Michigan and the Center for Clinical Management Research of the Ann Arbor Health System of Veterans Affairs, writes that the Treatment effect of this intervention was more modest than that achieved at black hair salons.

"These two tests had several differences that could explain the difference in results," they wrote. "First, the studies used different interventions. Behavioral change alone, such as that advocated by the FAITH study, has many benefits, but it is more difficult to lower blood pressure than drug management. Secondly, the hair salon trial resulted in a much larger participation of the participants in the intervention. Barbershop attendees received an average of seven pharmacy visits and four follow-up phone calls. By contrast, in the FAITH trial, only 46% of the participants in the intervention had participated in the three individual telephone counseling sessions. Third, although both trials included mainly low-income black adults, there were significant differences among their participants. The study on hairdressing salons was aimed exclusively at men who had at least one haircut every 6 weeks for at least 6 months. The participants in the FAITH study were predominantly women, but they may or may not attend the church regularly. These differences in eligibility criteria may also explain why the barber trial recorded a remarkably low attrition rate (<10% in each arm) at 6 months, whereas the FAITH trial had only complete data on 71% trials on low-income urban populations. "- by Erik Swain

For more information:

Gbenga
Ogedegbe, MD, MPH, FACP,
can be reached at 227 E. 30th St., 6th Floor, Room 633, New York, NY 10016; email: [email protected]; Twitter: @GbengaOgedegbe.

Disclosures: The authors, Heisler and Sussman, do not report any relevant financial information.