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Home > ARRA Stories > Dr. Gbenga Ogedegbe: Motivating Control of High Blood Pressure in African Americans
Dr. Gbenga Ogedegbe: Motivating Control of High Blood Pressure in African Americans

By Sara Harris

February 25, 2010

Photo of Dr. Gbenga Ogedegbe

Dr. Gbenga Ogedegbe (Photo by Mike Weymouth)

Gbenga Ogedegbe, M.D., M.P.H., Associate Professor of Medicine, Division of General Internal Medicine, New York University Department of Medicine; Director of the Center for Healthful Behavior Change, New York University Langone Medical Center

It's known as the silent killer. High blood pressure, or hypertension, has no symptoms, but it increases a person's risk for heart disease as well as stroke, two of the leading causes of death in the United States. A 2008 study found that nearly one-third of African Americans in New York City had high blood pressure. At one Manhattan hospital, researchers are exploring ways to diminish this risk.

The Problem: Approximately 50 percent of New Yorkers have uncontrolled high blood pressure, but some do not know they have it, others are not taking the right medications, and many cannot find a way to stick to an effective regimen of diet and exercise.

Doctors know patients can control high blood pressure by, for example, reducing their salt intake, being physically active, and eating fresh fruits and vegetables. Studies have confirmed that these changes work. New York University physician Gbenga Ogedegbe, M.D., M.P.H., asks, "If we take [these approaches] to a community-based practice with a large minority population, can we make this work?" With funding from the American Recovery and Reinvestment Act (ARRA), Dr. Ogedegbe aims to test a six-month intervention of patient education, goal setting and reinforcement at Bellevue Hospital, one of 23 affiliated facilities that serve 1.3 million New Yorkers regardless of their of ability to pay.

Finding a Solution: The study will enroll 250 African American adults with poorly controlled high blood pressure and follow them for six months. These men and women will have their blood drawn for testing and will document what they eat and how much they exercise. In addition, for a 24-hour period at both the start and end of the study, they will wear a portable blood-pressure monitoring device that automatically takes measurements every 20 to 30 minutes. Half the volunteers will receive standard care for high blood pressure throughout the study period. The other half will meet in groups weekly to talk about food choices that can lower blood pressure, the importance of reading nutrition labels, how to manage stress, the importance of medication, setting goals, and other topics that are keys to controlling blood pressure. After 12 weeks of these group classes, health counselors will begin calling and counseling the participants monthly for an additional three months to reinforce the self-management skills they acquired in the classes. The aim is to see how effective this kind of reinforcement is in getting people to lose weight and eat more fresh fruits and vegetables as well as to see whether they have lowered their blood pressure. This approach, which Dr. Ogedegbe calls motivational interviewing, "is where our program is different from every other program out there," he said. "You have to teach patients to maintain some of the skills."

In addition to examining the effectiveness of reinforcement and counseling, the study emphasizes the importance of a culturally sensitive approach. Although other NIH-funded studies may have proven that dietary modifications work, Dr. Ogedegbe said the patients he treats find some of the recommended food choices either unappealing or unaffordable. As part of this study, counselors will interview patients about what they like to eat and later take them shopping to find healthful choices and alternatives they can afford.

In separate studies, Dr. Ogedegbe and faculty at the Center for Healthful Behavior Change at New York University Langone Medical Center are exploring the effectiveness of interventions at senior centers, barbershops and churches, work that is supported by the National Center on Minority Health and Health Disparities and the National Heart, Lung, and Blood Institute. The research allows him to increase outreach in minority communities and to evaluate the potential of engaging community members as lay health advisors.

How This Funding Helps: ARRA funding will support staff salaries, educational materials, measuring equipment and supplies, and reimbursements for patients' participation. With a two-year timeline and ARRA's emphasis on jobs and results, Dr. Ogedegbe said, this is a study that requires "a lot of boots on the ground." The grant will provide part-time support for the project's four co-investigators. It will also fund five health counselors — hired through an independent firm — and their supervisors, in addition to a postdoctoral hypertension fellow, six research assistants and a project manager. "Typically, we don't hire that many people," he said.

After Two Years … By early March of 2010, the study's first patients will be enrolled. Dr. Ogedegbe expects initial results in March 2011. Should he find that the intervention was effective in lowering blood pressure, the next challenge will be disseminating the practice of motivational interviewing throughout New York City and beyond.

Recovery Act Investment: This project, entitled "Practice-Based Trial of Blood Pressure Control in African Americans," received $1,194,059 in fiscal 2009 from the NIH Office of the Director (administered by the National Heart, Lung, and Blood Institute).

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