African Americans Taught at Churches How to Lower Blood Pressure

O lord of Hosts, O just Judge, Who test the thoughts [kidneys] and the mind [heart], Let me see Your retribution upon them, For I lay my case before You. Jeremiah 11:20 (The Israel Bible™)

Attending religious services is surely good for the soul, but recent research also highlights its benefits for the body and the heart. Lifestyle intervention delivered in churches by community-based health workers has been shown to bring about a significant reduction in blood pressure among African Americans, compared to health education alone.

This conclusion was reached by researchers at New York University’s School of Medicine and the NYU Langone Medical Center who have just published their findings online in the journal Circulation: Cardiovascular Quality and Outcomes.

Meanwhile, Israeli researchers have contributed to the war against high blood pressure by performing for the first time in the country a procedure called cauterization on nerves in the kidneys. This procedure significantly reduced hypertension in patients whose blood pressure was not controlled by medications.

Churches are an influential institution for health promotion in black communities. While some faith-based interventions have successfully increased cancer screening, lowered weight and promoted better nutrition, this new study (named FAITH, or faith-based approaches in the treatment of hypertension) was the first of its kind to evaluate the effect of comprehensive lifestyle intervention for cutting blood pressure among African Americans in black churches. Dr. Gbenga Ogedegbe, a professor of population health and medicine at NYU’s School of Medicine and the study’s lead author, noted that African Americans tend to suffer from hypertension (high blood pressure) much more than other races.

They also have less access to medical care in clinics and hospitals, either because they don’t have proper health insurance or don’t go when needed to the doctor. But those with uncontrolled were found to better manage their blood pressure through programs administered in places of worship,” he said. Blacks in the US have a significantly greater burden of hypertension and heart disease, he added. “Vulnerable populations often have lower access to primary care. We need to reduce racial disparities in hypertension-related outcomes between blacks and whites. Additionally, we hope clergy and church leaders will take note of our findings and replicate these interventions in their churches.”

High blood pressure that is uncontrolled by medications can have devastating consequences. Among the possible complications are atherosclerosis (clogged arteries), which can lead to a heart attack and stroke; aneurysm (blood vessels weaken and bulge and eventually could explode and be life threatening);  heart failure (the inability of the heart to pump blood swiftly through its chambers, forcing it to pump harder and the muscle to get thicker); weakened and narrowed blood vessels in the kidneys; thickened, narrowed or torn blood vessels in the eyes, resulting in vision loss; metabolic syndrome, leading to type-2 diabetes; and memory problems and dementia.

NYU researchers collected data from 2010 to 2014 from 373 participants from 32 New York City churches who identified as black and had a self-reported diagnosis of hypertension and uncontrolled blood pressure. The research team then compared the effectiveness of a therapeutic lifestyle intervention plus motivational interviewing versus health education alone on blood pressure reduction among the participants. Results were analyzed after both six and nine months.

Participants in the intervention group received 11 weekly group sessions of 90 minutes each that focused on healthy lifestyle behaviors, plus three motivational interviewing sessions delivered by community health workers every month. The curriculum was uniquely tailored to church members by including prayer, scripture and faith-based discussion related to health. Participants in the control group received one lifestyle session on hypertension management, as well as 10 informational sessions on health education topics that were led weekly by health experts.

Motivational interviewing, explained Ogedegbe, enhanced the people’s desire and confidence to adopt healthy lifestyle behaviors. This was found to be especially effective for African Americans.

After six months, researchers saw a net reduction of 5.8 mm Hg in systolic blood pressure (when the heart is contracting) in the intervention group compared to the control group. Because the intervention was delivered by lay health advisors and not by nurses or doctors, it could not be determined whether issues of medication adherence were addressed during patient encounters in clinic. Using trusted members of the community to deliver care could reinforce the positive effects of reaching out to communities that have limited access or do not trust the medical community.

The study is limited because it could not determine how much of the difference in blood pressure resulted from lifestyle improvements and how much from changes in medication or better adherence to medication, Ogedegbe pointed out.

“Participants were encouraged to speak with their physicians about their medications and any problems they were experiencing. Future research should test an intervention that links the community and clinics as partners in delivering the intervention.”

The results may have been even more effective if intervention had included community-clinic partnerships to provide more comprehensive, structured health management, concluded Ogedegbe. “We plan to address this in new research that introduces community health workers into a team-based model of care for African Americans with poorly controlled high blood pressure.”

The Israel Accomplishment was carried out at Assaf Harofe (Yitzhak Shamir) Medical Center in the city of Tzrifin, 15 kilometers east of Tel Aviv. The innovative technology used a unique technique that enables safe and efficient burning of the nerve fibers of the kidneys using a novel method that has been successfully tested in several recent studies.

For the first time in Israel, the kidney nerve fibers were cauterized using the unique Symplicity Spyral ™ recording system of the international Medtronic Corporation. The technique, which takes about one hour and is performed without anesthesia under sedation, has been proven to involve an extremely low complication rate. The results of the treatment will be monitored over the next few months.

Prof. Shmuel Fuchs, director of the hospital’s cardiology department, and Dr. Sa’ar Minha, director of the cardiology interdisciplinary unit, who performed the procedure concluded: “The challenge we face in cardiovascular medicine is to make personalized treatment accessible to patients using innovative technologies to achieve optimal improvement.”

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