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Methods Papers

Counseling African Americans to Control Hypertension (CAATCH) Trial

A Multi-Level Intervention to Improve Blood Pressure Control in Hypertensive Blacks

Gbenga Ogedegbe, MD, MPH, MS; Jonathan N. Tobin, PhD; Senaida Fernandez, PhD; William Gerin, PhD; Marleny Diaz-Gloster, MPH; Andrea Cassells, MPH; Chamanara Khalida, MD; Thomas Pickering, MD, DPhil; Antoinette Schoenthaler, EdD and Joseph Ravenell, MD, MS

From the Department of Medicine (G.O., S.F., A.S., J.R.), Division of General Internal Medicine and Center for Healthful Behavior Change, New York University School of Medicine; Clinical Directors Network (J.N.T., M.D.-G., A.C., C.K.) and the Department of Epidemiology and Population Health (J.N.T.), Albert Einstein College of Medicine of Yeshiva University, New York, NY; the Department of Biobehavioral Health (W.G.), College of Health and Human Development, Pennsylvania State University, State College, Pa; and the Department of Medicine (T.P.), Columbia University, New York, NY.

Correspondence to Gbenga Ogedegbe, MD, MPH, MS, Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, 423 E 23rd St, 15N-168, New York, NY 10010. E-mail olugbenga.ogedegbe{at}nyumc.org

Despite strong evidence of effective interventions targeted at blood pressure (BP) control, there is little evidence on the translation of these approaches to routine clinical practice in care of hypertensive blacks. The goal of this study is to evaluate the effectiveness of a multilevel, multicomponent, evidence-based intervention compared with usual care in improving BP control among hypertensive blacks who receive care in community health centers. The primary outcomes are BP control rate at 12 months and maintenance of intervention 1 year after the trial. The secondary outcomes are within-patient change in BP from baseline to 12 months and cost-effectiveness of the intervention. Counseling African Americans to Control Hypertension (CAATCH) is a group randomized clinical trial with 2 conditions: intervention condition and usual care. Thirty community health centers were randomly assigned equally to the intervention condition group (n=15) or the usual care group (n=15). The intervention comprises 3 components targeted at patients (interactive computerized hypertension education, home BP monitoring, and monthly behavioral counseling on lifestyle modification) and 2 components targeted at physicians (monthly case rounds based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, chart audit and provision of feedback on clinical performance and patients’ home BP readings). All outcomes are assessed at quarterly study visits for 1 year. Chart review is conducted at 24 months to evaluate maintenance of intervention effects and sustainability of the intervention. Poor BP control is one of the major reasons for the mortality gap between blacks and whites. Findings from this study, if successful, will provide salient information needed for translation and dissemination of evidence-based interventions targeted at BP control into clinical practice for this high-risk population.

Key Words: hypertension • clinical trial • blacks • research

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