May 21, 2012

May 21, 2012 (New York, New York)— A cardiovascular risk reduction tool kit developed by the International Society on Hypertension in Blacks (ISHIB) helped reduce systolic and diastolic blood pressure levels in African American hypertensive patients to a greater extent than patients treated with usual care, a new preliminary report suggests.

Individuals who received the cardiovascular tool kit, known as IMPACT, had an 18.7-mm-Hg reduction in systolic blood pressure and a 9.7-mm-Hg reduction in diastolic blood pressure, both of which were significantly larger than the in patients who were treated with usual care.

"This is an intervention used in a difficult-to-treat patient population," lead investigator Dr Wallace Johnson (University of Maryland School of Medicine, Baltimore) told heartwire . "It's low-tech, by design, and it's low cost, and it appears to have an impact in terms of what the numbers show. Therapies in today's healthcare climate need to be able to show an effect and be cost-effective in order to be sustainable. In today's climate, that which is not cost-effective is the same thing as a dinosaur. You might as well call it a Tyrannosaurus rex because it just won't exist."

The IMPACT Tool Kit

Presenting the results of the study here at the American Society of Hypertension 2012 Scientific Sessions, Johnson said there is a well-recognized disparity in cardiovascular mortality rates among African Americans compared with other ethnicities. Among patients with equivalent blood-pressure levels, the African American patient will tend to have more end-organ damage and complications from hypertension, as well as more difficulty getting to treatment goal, than non–African Americans. In an attempt to modify blood-pressure levels in African American patients, ISHIB developed the IMPACT program using different lifestyle-modification strategies.

The IMPACT tool kit comprises a home blood-pressure monitor; pedometer; a DVD with tips on healthy walking; refrigerator magnets with tips on healthy eating, meal measurements that help identify portion sizes for fish, meat, poultry, fruits, and vegetables; and a binder with information on high blood pressure, lifestyle/behavioral changes, diet modifications, ways to reduce salt intake, and recommendations for physical activity and stress management. The IMPACT project is an effort to implement and sustain therapeutic lifestyle changes and to translate the recommendations of the ISHIB 2009 hypertension management consensus statement to community practices.

"We've often seen something come out as a paper, and there's such a delay before it actually makes its way into community practice," said Johnson.

In the present study, the researchers evaluated the short-term effects of the IMPACT program on blood-pressure levels in 32 adult patients with hypertension recruited from community-based primary-care physician offices. The patients were randomized to the intervention arm and received the IMPACT tool kit and information in addition to usual care, while the control arm received usual care alone. Treatment with usual care alone reduced mean systolic and diastolic blood-pressure levels 6.7 mm Hg and 5.0 mm Hg, respectively, while the IMPACT-intervention arm had reductions of 18.7 mm Hg and 9.7 mm Hg, respectively, both of which were significant compared with the control arm.

Johnson told heartwire the one-month data are simply a snapshot of the effectiveness of the IMPACT program, and the group plans to follow these and more patients for 12 months. The most important aspect of the program, he believes, is simply the amount of extra time spent with patients--namely the time physicians and "physician-extenders" spend devoted to the problem of high blood pressure. The IMPACT tool kit also includes a single-page treatment algorithm for physicians treating African American patients. The algorithm adheres to the Seventh Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), although it differs slightly to account for the higher-risk African American patients.