在黑人中控制不下的高血压的实践便利和同行辅导:一项随机临床试验
Monika M Safford1, Doyle M Cummings2, Jacqueline R Halladay3
1Weill Medical College of Cornell University, New York, New York.
JAMA internal medicine
|March 18, 2024
概括
同行指导 (PC) 和实践促进 (PF) 并没有改善农村黑人成年人的血压 (BP) 控制. 然而,PC在60岁以下的成年人中显著降低了缩血压.
科学领域:
- 心血管健康 心血管健康
- 公共卫生干预 公共卫生干预
- 高血压管理 高血压管理
背景情况:
- 农村黑人成年人在实现最佳血压 (BP) 控制方面遇到挑战.
- 有效的干预措施对于管理这一群体的高血压至关重要.
研究的目的:
- 为了比较同行辅导 (PC),实践便利化 (PF) 和PC和PF (PCPF) 联合与增强的常规护理 (EUC) 的有效性,以改善非控制高血压的农村黑人成年人的血压控制.
主要方法:
- 一个集群随机临床试验,涉及69个阿拉巴马州和北卡罗来纳州的农村初级保健实践.
- 患有持续失控高血压的参与者被随机分为四组:PC加EUC,PF加EUC,PCPF加EUC和单独EUC.
- 干预措施包括12个月的结构化基于电话的自主管理同行指导和质量改进项目的实践便利.
主要成果:
- 无论是PC,PF还是PCPF都没有在12个月后与EUC相比,在整体血压控制方面显示出统计学上显著的改善.
- 预先计划的小组分析显示,PC和PCPF组的60岁以下的参与者与EUC组相比,缩血压下降幅度明显增加5mmHg.
- 在PF组中,全实践范围的BP控制估计表明PF从54%改善到61%,尽管这在个人参与者中没有观察到.
结论:
- 同行指导和实践便利,单独或组合,并不优于增强的通常护理,以改善整体血压控制在这个队列.
- 同行辅导通过显著降低年轻成年人 (60岁以下) 的静缩血压,显示出潜在的益处.
- 可能需要进一步的研究来优化在农村黑人人口中持续控制血压的干预措施.
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