A comprehensive cardiovascular disease lifestyle treatment controlled trial among high-risk African Americans

Sharon K. Davis, Rakale Quarells, Gary H. Gibbons

Morehouse School of Medicine, Social Epidemiology Research Center, Cardiovascular Research Institute, Atlanta, USA.
National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, USA.
National Institutes of Health, National Human Genome Research Institute, Bethesda, USA.

DOI: 10.4236/ojpm.2013.39071                

Abstract

Background: The purpose of this study was to assess the effects of a comprehensive lifestyle intervention on modifiable cardiovascular risk factors among high-risk African Americans. Methods: The study included a randomized treatment/controlled intervention trial among 136 African Americans residing in Atlanta, GA who were overweight and had elevated blood pressure. The treatment group was exposed to 3-months of a multi-component intervention and the control to an abbreviated 6-week intervention after the completion of the treatment group’s intervention. The main outcomes included mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean waist circumference, mean body mass index (BMI), mean number of times exercise per week, mean number of servings of fruits and vegetables per day, and mean level of daily stress. Data were collected at baseline and at 6-month follow-up. Separate linear regressions were used with an established significance level of P < 0.05. Results: Results revealed significant net improvement in treatment group when compared to controls in waist circumference, BMI, times weekly exercise, servings of fruit and vegetables per day (P < 0.001, 0.04, 0.02, 0.002, respectively). Diastolic blood pressure also significantly improved within the treatment group for overall hypertensives from baseline to 6-month follow-up (90.9 mmHg to 83.1 mmHg, P = 0.002). Conclusion: These results show that a comprehensive lifestyle intervention can improve cardiovascular risk factor profile among high risk African Americans. Caregivers should encourage patients to participate in such programs and public health policymakers should allocate resources to community based health oriented organizations to implement comprehensive lifestyle program.

Keywords

African American; Cardiovascular Disease Risk Factors; Lifestyle Modification

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	(2012) Fact book: Fiscal year 2011. National Institutes of Health, National Heart, Lung, and Blood Institute.
[2]	(2012) Health, United States, 2011: With special feature on socioeconomic status and health. National Center for Health Statistics, Hyattsville.
[3]	Blumenthal, J.A., Sherwood, A., Gullette, C.D., Baya, K.M., Waugh, R., Georgiades, A., Craighhead, L.W., Tweedy, D., Feinglos, M., Applbaum, M., Hayno, J. and Hinderliter, A. (2000) Exercise and weight loss reduce blood pressure in men and women with mild hypertension. Archives of Internal Medicine, 160, 1947-1958. http://dx.doi.org/10.1001/archinte.160.13.1947
[4]	Oexmann, M.J., Thomas, J.C., Taylor, K.B., O’Neil, P.M., Garvey, T., Lackland, D.T. and Egan, B.M. (2000) Short-term impact of a church-based approach to lifestyle change on cardiovascular risk in African Americans. Ethnicity & Disease, 10, 17-23.
[5]	Rimmer, J.H., Braquncnhweig, C., Silverman, K., Riley, B., Creviston, T. and Nicola, T. (2000) Effects of a shortterm health promotion intervention for a predominantly African American group of stroke survivors. American Journal of Preventive Medicine, 18, 332-338. http://dx.doi.org/10.1016/S0749-3797(00)00129-X
[6]	Miller, E.B., Erlinger, T.P., Young, D.B., Jehn, M., Charleston, J., Rhodes, D., Wasan, S.K. and Appel, L.J. (2002) Results of the diet, exercise, and weight loss intervention trial (DEW-IT). Hypertension, 40, 612-618. http://dx.doi.org/10.1161/01.HYP.0000037217.96002.8E
[7]	Writing Group of the PREMIER Collaborative Research Group (2003) Effects of comprehensive lifestyle modifycation on blood pressure control: Main results of the PREMIER clinical trial. Journal of the American Medical Association, 298, 2083-2093.
[8]	Stewart, K.J., Bacher, A.C., Turner, K.L., Fleg, J.L., Hees, P.S., Shapiro, E.P., Tayback, M. and Ouyang, P. (2005) Effect of exercise on blood pressure in older persons. Archives of Internal Medicine, 165, 756-762. http://dx.doi.org/10.1001/archinte.165.7.756
[9]	Villablanca, A.C., Beckett, L.A., Li, Y., Leatherwood, S., Gill, S.K., Giardina, E.-G. V., Taylor, A.L., Barron, C., Foody, J.M., Haynes, S. and D’Onofrio, G. (2010) Outcomes of comprehensive health care program in high-risk women. Journal of Women’s Health, 19, 131-1325.
[10]	Baley, D.M., Kaufman, P.G., Raczynski, J.M., Murphy, J.K., Rosner, B., Corrigan, S.A., Rappaport, N.B., Danielson, E.M., Lasser, N.L. and Kuhn, C.M. (2000) Stress management intervention for primary prevention of hypertension: Detailed results from phase I of trials of hypertension prevention (TOHP-I). Annals of Epidemiology, 10, 45-58. http://dx.doi.org/10.1016/S1047-2797(99)00041-1
[11]	(2003) Seventh Report Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension, 42, 1206-1252. http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2
[12]	National Heart, Lung, and Blood Institute Obesity Education Initiative (2000) The practical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. NIH Publication Number 00-4084.
[13]	Brownell, E.D. (1994) The LEARN Program for weight control. 6th Edition, American Health Publication Co., Dallas.
[14]	Bowen, D., Clifford, C.K., Coates, R., Evans, M., Feng, Z., Fouad, M., George, V., Gerace, T., Grizzle, J.E., Hall, W.D., Heam, M., Henderson, M., Kestin, M., Kristal, A., Leary, E.T., Lewis, C.E., Oberman, A., Prenctice, R., Raczynski, J., Tolvola, B. and Unban, N. (1996) The women’s health feasibility study in minority populations: Design and baseline descriptions. Annals of Epidemiology, 6, 507-519. http://dx.doi.org/10.1016/S1047-2797(96)00072-5
[15]	Harsha, D.W., Lin, P.H., Obarzanck, E., Karanja, N.M., Moore, T.J., Caballero, B. and DASH Collaborative Research Group (1999) Dietary approaches to stop hypertension: A summary of study results. Journal of the American Dietetic Association, 99, S35-S39. http://dx.doi.org/10.1016/S0002-8223(99)00414-9
[16]	Schneider, R.H., Stagger, F., Alexander, C.N., Sheppard, W., Rainforth, M., Kondwoni, K., Smith, S. and King, C.G. (1995) A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension, 26, 820-827. http://dx.doi.org/10.1161/01.HYP.26.5.820
[17]	CDC (2006-2007) Behavioral risk factor surveillance system survey questionnaires. US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta.
[18]	Davis, S.K., Liu, Y., Collins-Quarells, R. and Din-Dzietham, R. (2005) Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans the metro atlanta heart disease study. Ethnicity & Disease, 15, 585-593.
[19]	SAS Institute Inc. (2008) Version 9.2 user’s guide. SAS Institute Inc., Cary.
[20]	Daucher, L., Kesse-Guyot, E., Czemichow, S., Bertrais, S., Estaquio, C., Peneau, S., Vergnaud, A.C., Chat-Young, S., Castetbon, K., Deschampo, V., Brindel, P. and Hereberg, S. (2007) Dietary patterns and blood pressure change over 5-year follow-up in the SV.VI.Max cohort. American Journal of Clinical Nutrition, 85, 1650-1656.
[21]	Schulze, M.B., Hoffman, K., Kroke, A. and Boeing, H. (2003) Risk of hypertension among women in the EPIC-potsdam study: Comparison of relative risk estimates for exploratory and hypothesis-oriented dietary patterns. American Journal of Epidemiology, 158, 365-373. http://dx.doi.org/10.1093/aje/kwg156