The Counseling African Americans to Control Hypertension Study and Ways to Enhance the Next Wave of Behavioral Interventions
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The Counseling African Americans to Control Hypertension (CAATCH) study by Ogedegbe et al1 in this issue of Circulation represents a carefully done study with many strengths. It recognized that blacks have the highest prevalence of hypertension2 and that poor hypertension-related outcomes explain most of the racial gap in mortality between blacks and whites.3 It represents the largest practice-based implementation trial to date of a multilevel, evidence-based intervention targeted at blood pressure (BP) control in hypertensive blacks in community health centers, where many low-income Americans receive their care. In addition, although the individual components of CAATCH (patient education, home BP monitoring, continuing medical education, physician chart audit, and feedback) have proven efficacious and effective for improving BP control,1 the effectiveness of a combined approach in community health centers has not been rigorously evaluated. The study was adequately powered to detect a difference of ≥4 mm Hg for systolic BP and 3 mm Hg for diastolic BP at 12 months between intervention and control arms assuming a 15% attrition rate. However, the intervention did not have any impact in improving BP control relative to a randomly selected control group. This disappointing result highlights the challenge of creating successful practice-based interventions in the settings where implementation at scale is possible. The lack of success begs for closer examination.
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The investigators took what would be considered a standard and credible intervention approach at the time they launched this study in 2004. Patient study participants were given home BP monitors and asked to record the readings in diaries (twice per day, 3 times per week). They were also given 4 modules of interactive computerized patient education focused on the causes, complications, and treatment of hypertension; expected medication adverse effects; and methods for adoption of healthy lifestyle behaviors …