Culturally tailored lifestyle coaching can help Black adults with hypertension improve their blood pressure control, new Kaiser Permanente research shows. Improving blood pressure control is key to reducing risk for stroke, heart attack, and other hypertension-related health problems.

Black adults have the highest rates of high blood pressure in the United States, and, for reasons we don't fully understand, it starts at a younger age and results in strokes, heart attacks, heart failure, chronic kidney disease, and other serious hypertension-related health problems occurring at an earlier age as well. We know how to treat high blood pressure with medication, but there is also a huge role that behavior change can play in prevention and treatment. This study was a tremendous opportunity to see if we had an intervention that could change behaviors and get blood pressure under control."

Stephen Sidney, MD, MPH, study's senior author, research scientist, Kaiser Permanente Division of Research

The study, published May 18 in JAMA Network Open, included 1,761 Black adults with high blood pressure who were members of Kaiser Permanente in Northern California. The patients joined 1 of 3 groups: usual care; usual care and a 12-month enhanced medication management; or usual care and a 12-month coaching program of 16 phone sessions with a registered dietitian who talked to them about their diet choices and helped them lower their salt intake by adhering to the DASH (Dietary Approaches to Stop Hypertension) eating plan. Then, the researchers analyzed the impact the programs had on blood pressure control at 12, 24, and 48 months post-enrollment.

Statistical analyses showed no significant difference in blood pressure control among the 3 groups after 12 months. However, at both the 24-month and the 48-month mark, blood pressure control was significantly better among the patients who had received the lifestyle coaching than it was among patients in the enhanced medication management program or the usual care only group. At 24 months post-enrollment, 72.4% of the patients who received lifestyle coaching had controlled blood pressure, compared with 67.6% of the patients in the enhanced medication management program and 61.2% of patients receiving usual care. At 48 months the differences were sustained, with 73.1% of the patients in the lifestyle coaching group showing controlled blood pressure compared with 66.5% of the patients in the enhanced medication management program and 64.5% of the patients receiving usual care.

"We had hoped that a 12-month coaching program could help people learn how to start a healthy, low-salt eating plan," said lead author Mai N. Nguyen-Huynh, MD, a research scientist at the Kaiser Permanente Division of Research and the Kaiser Permanente Northern California regional medical director for primary stroke for The Permanente Medical Group. "But what was really eye-opening was learning that after the 1-year program ended these patients continued to have better blood pressure control, perhaps by sticking with the lifestyle changes they had learned -; even though we had no contact with them."

Back adults have significantly higher rates of high blood pressure than white, Latino, and Asian adults, and lower rates of blood pressure control. High blood pressure can cause damage to the arteries throughout the body, increasing the risk of a heart attack, stroke, dementia, or heart failure. The new study was funded through a national effort aimed at developing programs to reduce stroke disparities in racial/ethnic, rural, or lower socioeconomic populations.

The researchers said they believe their findings could lead to the introduction of similar programs that can help Black adults learn about dietary changes that improve blood pressure control. "This research opens up the door for the creation of programs that could be offered on a larger scale that implement the principles of coaching for behavioral change that we have shown can be effective," said Dr. Sidney.

Added Dr. Nguyen-Huynh: "This is the only trial that has shown that a lifestyle coaching intervention can bring about changes that lead to better blood pressure control long after the intervention has ended. We've learned from the participants' feedback what they felt were the most helpful aspects of the program, and we can use them to guide our next steps."