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Стратегии снижения артериального давления для устранения различий в гипертонии (BLESSED) (BLESSED)

28 сентября 2026 г. обновлено: Jiang He, MD, PhD, Tulane University

Стратегии снижения артериального давления для устранения различий в гипертонии

The burden of hypertension and related cardiovascular diseases, stroke, and end-stage kidney disease is disproportionately high in Black populations, especially in the South. The Blood Pressure Lowering Strategies to Eliminate Hypertension Disparities (BLESSED) cluster randomized trial aims to test the effectiveness, implementation, and sustainability of a community health worker (CHW)-led multifaceted intervention compared to enhanced usual care for hypertension control in Black communities. In the BLESSED trial, the investigators plan to recruit 1,176 adults with hypertension (approximately 28 per church) from 42 predominantly Black churches in the Greater New Orleans area. The multifaceted intervention will last for 18 months, followed by a post-intervention follow-up visit at 24 months. The BLESSED trial aims to generate evidence regarding the effectiveness, implementation, and sustainability of this CHW-led church-based multifaceted intervention in eliminating hypertension disparities in the United States (US) general population.

Обзор исследования

Статус

Рекрутинг

Условия

Вмешательство/лечение

Подробное описание

Louisiana residents, especially African Americans, bear a disproportionately high burden of hypertension and cardiovascular disease (CVD). In the Blood Pressure Lowering Strategies to Eliminate Hypertension Disparities (BLESSED) cluster randomized trial, the investigators will compare the impact of two implementation strategies - a CHW-led multifaceted strategy and a group-based education strategy - for delivering interventions recommended by the 2017 American College of Cardiology (ACC) and the American Heart Association (AHA) hypertension clinical guidelines on implementation and clinical effectiveness outcomes in predominantly Black community members over 18 months. The BLESSED study utilizes an effectiveness-implementation hybrid design to: (1). test the effectiveness of a CHW-led church-based multifaceted implementation strategy for reducing estimated CVD risk over 18 months among African American church community members at high risk for CVD, and (2). assess the implementation outcomes (acceptability, adaptation, adoption, feasibility, fidelity, penetrance, cost-effectiveness, and sustainability) simultaneously. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework has guided the development and evaluation of the multifaceted implementation strategy, which includes CHW-led health coaching on lifestyle changes and medication adherence; healthcare delivery in community; church-based exercise and weight loss programs; self-monitoring of blood pressure (BP); and provider education and engagement. The CHW-led church-based intervention will provide strong social support and tackle multiple social determinants of CVD disparities. The primary clinical effectiveness outcome is the difference in mean change of systolic blood pressure (SBP) from baseline to 18 months between intervention and control groups. The primary implementation outcome is a fidelity summary score for key implementation strategy components to the CHW-led church-based multifaceted implementation strategy assessed at the participant levels. This study has 90% statistical power to detect group differences in mean SBP change of 5.8 mm Hg over 18 months using a 2-sided significance level of 0.05. The investigators will recruit 1,176 participants (28 per church) who are aged ≥18 years with systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mm Hg, and randomly assign 21 churches to intervention and 21 to control; the investigators will implement the multifaceted intervention program; the investigators will follow-up participants and collect data on effectiveness and implementation outcomes at 6, 12, and 18 months; the investigators will evaluate the sustainability of the intervention at 6 months post-intervention; and the investigators will perform intention-to-treat analyses and disseminate and scale-up the proven-effective implementation strategy. The proposed study will generate evidence on the effectiveness, implementation, and sustainability of the multifaceted intervention aimed at eliminating CVD disparities in African American populations in the US.

Тип исследования

Интервенционный

Регистрация (Оцененный)

1176

Фаза

  • Непригодный

Контакты и местонахождение

В этом разделе приведены контактные данные лиц, проводящих исследование, и информация о том, где проводится это исследование.

Места учебы

  • Соединенные Штаты
    • Louisiana
      • New Orleans, Louisiana, Соединенные Штаты, 70112
        • Рекрутинг
        • Tulane University
        • Контакт:
          • Jodie Laurent, MPH
          • Номер телефона: 504-988-5432
          • Электронная почта: jlaurent@tulane.edu
        • Контакт:
          • Allison N Marshall, PhD MPH MSSW
          • Номер телефона: 5049886454
          • Электронная почта: amarshall@tulane.edu

Критерии участия

Исследователи ищут людей, которые соответствуют определенному описанию, называемому критериям приемлемости. Некоторыми примерами этих критериев являются общее состояние здоровья человека или предшествующее лечение.

Критерии приемлемости

Возраст, подходящий для обучения

18 лет и старше (Взрослый, Пожилой взрослый)

Принимает здоровых добровольцев

Нет

Полы, имеющие право на обучение

Все

Описание

Inclusion Criteria:

  1. Men or women aged ≥18 years
  2. Community members associated with the participating churches (church members and their families and friends)
  3. Systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mm Hg
  4. Willing and able to participate in the intervention.
  5. Willing and able to sign written informed consent.

Exclusion Criteria:

  1. Prior hospitalization in the last 3 months for chronic heart failure or heart attack
  2. Current diagnosis of cancer requiring chemotherapy or radiation therapy
  3. Stage-5 chronic kidney disease requiring chronic dialysis or transplant
  4. Pregnant or planning to become pregnant in the next 18 months
  5. Planning to move out of the Greater New Orleans area during the next year

Учебный план

В этом разделе представлена ​​подробная информация о плане исследования, в том числе о том, как планируется исследование и что оно измеряет.

Как устроено исследование?

Детали дизайна

  • Основная цель: Профилактика
  • Распределение: Рандомизированный
  • Интервенционная модель: Параллельное назначение
  • Маскировка: Одинокий

Оружие и интервенции

Группа участников / Армия
Вмешательство/лечение
Экспериментальный: Community health worker-led implementation strategy

CHW-led church-based multifaceted implementation strategy: CHWs will conduct individualized health coaching and healthcare navigation, organize church-based health promotion programs (e.g., nutrition education and exercise sessions), and train and assist the study participants in self-monitoring of BP. Nurse practitioners will see study participants at church settings, and community pharmacies will deliver antihypertensive medications to patients' homes.
Поведенческий: Behavioral: Evidence-based interventions recommended by the 2017 ACC/AHA hypertension clinical guideline

The recommended evidence-based interventions include therapeutic lifestyle change and medical treatment of hypertension
Экспериментальный: Group-based Education Strategy

The investigator team will work with church leadership and wellness coordinators to organize group-based education sessions. Health education will be delivered by local primary care providers, dieticians, and health educators. Contact information for primary care providers and information on self-monitoring of BP will also be given at group sessions.
Поведенческий: Behavioral: Evidence-based interventions recommended by the 2017 ACC/AHA hypertension clinical guideline

The recommended evidence-based interventions include therapeutic lifestyle change and medical treatment of hypertension

Что измеряет исследование?

Первичные показатели результатов

Мера результата
Мера Описание
Временное ограничение
Difference in mean change of systolic blood pressure
Временное ограничение: Measured from baseline to 18 months

Difference in mean change of systolic blood pressure from baseline to 18 months between intervention and control groups
Measured from baseline to 18 months
Implementation fidelity summary score
Временное ограничение: Measured at 6, 12, and 18 months

The fidelity summary score is composed of the following key implementation strategy components: proportion of assigned health education sessions attended in all participants, proportion of assigned discussion sessions attended in all participants, proportion of recommended minutes of physical activity completed in all participants, proportion of days per week that fruits/vegetables are eaten as recommended in all participants, proportion of recommended home blood pressure (BP) monitoring completed in patients with hypertension, proportion of required provider visits attended in all patients, and proportion of antihypertensive medications taken in patients with hypertension. The score ranged from zero to six with a higher score indicates greater fidelity.
Measured at 6, 12, and 18 months

Вторичные показатели результатов

Мера результата
Мера Описание
Временное ограничение
Difference in the proportion of patients with controlled BP between intervention and control groups
Временное ограничение: Measured from baseline to 18 months

Difference in the proportion of patients with controlled BP (<130/80 mm Hg) between intervention and control groups at 18 months
Measured from baseline to 18 months
Difference in mean change of diastolic BP
Временное ограничение: Measured from baseline to 18 months

Difference in mean change of diastolic BP (DBP) from baseline to 18 months between intervention and control groups
Measured from baseline to 18 months
Side effects of medications and adverse events
Временное ограничение: Measured from baseline to 18 months

Change in side effects of medications and adverse events from baseline to 18 months
Measured from baseline to 18 months
Cost-effectiveness
Временное ограничение: Measured from baseline to 18 months

Cost-effectiveness assessed as incremental direct costs per additional percentage of hypertension control
Measured from baseline to 18 months
Acceptability
Временное ограничение: Measured from baseline to 18 months

Percentage of participants, community health worker, providers, and church administrators who reply that the intervention is acceptable (satisfactory). Measured by survey.
Measured from baseline to 18 months
Adoption (Churches)
Временное ограничение: Measured from baseline to 18 months

% of churches adopting the intervention program
Measured from baseline to 18 months
Adoption (Providers)
Временное ограничение: Measured from baseline to 18 months

% of invited providers attending training sessions
Measured from baseline to 18 months
Appropriateness
Временное ограничение: Measured from baseline to 18 months

Percentage of participants, community health workers, providers, and church administrators who reply that the intervention is appropriate (good perceived fit). The outcome will be measured by survey question.
Measured from baseline to 18 months
Feasibility to participant, community health worker, provider and churches
Временное ограничение: Measured from baseline to 18 months

Percentage of participants, community health worker, providers, and church administrators who reply that the intervention is feasible (actual fit, suitability). Measured by survey and study administrative data.
Measured from baseline to 18 months
Exercise Session Fidelity (community health worker-led strategy group)
Временное ограничение: Measured at 6, 12, and 18 months

Percentage of exercise sessions organized. Measured by study administrative data.
Measured at 6, 12, and 18 months
Fidelity of Group Health Education Session
Временное ограничение: Measured at 6, 12, and 18 months

Percentage of group health education sessions conducted out of health educated sessions planned per study protocol.
Measured at 6, 12, and 18 months
Nutrition Education Session Fidelity (community health worker-led strategy group)
Временное ограничение: Measured at 6, 12, and 18 months

Percentage of nutrition education sessions organized. Measured by study administrative data.
Measured at 6, 12, and 18 months
Health Care Appointment Fidelity (community health worker-led strategy group)
Временное ограничение: Measured at 6, 12, and 18 months

Percentage of health care visit appointments made. Measured by study administrative data.
Measured at 6, 12, and 18 months
Percentage of enrolled participants receiving assigned intervention. Measured by study administrative data. Reach (Participants)
Временное ограничение: Measured at baseline, 6, 12, and 18 months

Percentage of enrolled participants receiving assigned intervention. Measured by study administrative data.
Measured at baseline, 6, 12, and 18 months
Reach (Participants)
Временное ограничение: Measured at baseline

The percentage of eligible/screened/contacted participants enrolled. Measured by study data, administrative data.
Measured at baseline
Penetrance (Participants)
Временное ограничение: Measured at baseline, 6, 12, and 18 months

Percentage of enrolled participants receiving assigned intervention. Measured by intervention monitoring data.
Measured at baseline, 6, 12, and 18 months
Penetrance (Providers)
Временное ограничение: Measured at baseline, 6, 12, and 18 months

Percentage of trained providers delivering protocol-based care. Measured by intervention monitoring data.
Measured at baseline, 6, 12, and 18 months
Penetrance (educators)
Временное ограничение: Measured at baseline, 6, 12, and 18 months

Percentage of trained CHWs or providers and health educators delivering health coaching. Measured by intervention monitoring data.
Measured at baseline, 6, 12, and 18 months
Sustainability (Churches)
Временное ограничение: Measured at baseline, 6, 12, and 18 months

Percentage of churches continuing the intervention program and individual components. Measured by 6-month post-intervention survey.
Measured at baseline, 6, 12, and 18 months
Sustainability (Participants)
Временное ограничение: Measured at 24 months

Percentage of participants maintaining ideal cardiovascular health metrics, healthy lifestyle components, and adherence to medications. Measured by 6-month post-intervention survey and examination.
Measured at 24 months
Sustainability Effectiveness Outcome: Differences in mean change of SBP and DBP
Временное ограничение: Measured at baseline and 24 months

Differences in mean change of SBP and DBP from baseline to 24 months (6 months post-intervention) between intervention and control groups
Measured at baseline and 24 months
Sustainability Effectiveness Outcome: Difference in the proportion of patients with controlled BP
Временное ограничение: Measured at baseline and 24 months

Difference in the proportion of patients with controlled BP (<130/80 mm Hg) between intervention and control groups at 24 months.
Measured at baseline and 24 months
Sustainability of Fidelity
Временное ограничение: Measured at 24 months

A fidelity summary score for key implementation strategy components at 6 months post-intervention (24 months overall). The fidelity summary score is composed of the following key implementation strategy components: proportion of assigned health education sessions attended in all participants, proportion of assigned discussion sessions attended in all participants, proportion of recommended minutes of physical activity completed in all participants, proportion of days per week that fruits/vegetables are eaten as recommended in all participants, proportion of recommended home BP monitoring completed in patients with hypertension, proportion of required provider visits attended in all patients, and proportion of antihypertensive medications taken in patients with hypertension. Fidelity score ranges from zero to six with a higher score indicates greater fidelity.
Measured at 24 months

Другие показатели результатов

Мера результата
Мера Описание
Временное ограничение
Change in quality of life
Временное ограничение: Measured from baseline to 18 months

The difference in QoL between the two arms over 18 months. QoL will be assessed using the SF-12 questionnaire. Scores range from 0 to 100, with higher scores indicating better physical and mental health functioning.
Measured from baseline to 18 months

Соавторы и исследователи

Здесь вы найдете людей и организации, участвующие в этом исследовании.

Спонсор

Tulane University

Соавторы

National Institute on Minority Health and Health Disparities (NIMHD)
National Institutes of Health (NIH)

Публикации и полезные ссылки

Лицо, ответственное за внесение сведений об исследовании, добровольно предоставляет эти публикации. Это может быть что угодно, связанное с исследованием.

Общие публикации

Даты записи исследования

Эти даты отслеживают ход отправки отчетов об исследованиях и сводных результатов на сайт ClinicalTrials.gov. Записи исследований и сообщаемые результаты проверяются Национальной медицинской библиотекой (NLM), чтобы убедиться, что они соответствуют определенным стандартам контроля качества, прежде чем публиковать их на общедоступном веб-сайте.

Изучение основных дат

Начало исследования (Действительный)

1 ноября 2023 г.

Первичное завершение (Оцененный)

30 июня 2027 г.

Завершение исследования (Оцененный)

30 июня 2027 г.

Даты регистрации исследования

Первый отправленный

1 ноября 2023 г.

Впервые представлено, что соответствует критериям контроля качества

10 ноября 2023 г.

Первый опубликованный (Действительный)

15 ноября 2023 г.

Обновления учебных записей

Последнее опубликованное обновление (Действительный)

1 октября 2026 г.

Последнее отправленное обновление, отвечающее критериям контроля качества

28 сентября 2026 г.

Последняя проверка

1 сентября 2026 г.

Дополнительная информация

Термины, связанные с этим исследованием

Ключевые слова

Дополнительные соответствующие термины MeSH

Другие идентификационные номера исследования

  • 2022-1081-SPHTM
  • R01MD018193 (Грант/контракт NIH США)

Планирование данных отдельных участников (IPD)

Планируете делиться данными об отдельных участниках (IPD)?

ДА

Описание плана IPD

The study data sharing plan will comply with all NIH policies for data sharing. Data sharing will be executed through the centralized NIH data repository and will be implemented in a timely manner. The study data, including data from baseline and follow-up visits, will be prepared for transmission to the NHLBI data repository - the Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC). The datasets will be submitted to the NHLBI no later than three years after the end of the final participant follow-up or two years after the main paper of the trial has been published, whichever comes first. The NHLBI will review the submitted data prior to release. These data will be free of identifiers that allow identification of individual research participants either directly or through "deductive disclosure." In addition, the investigators will offer, through a publicly accessible website, opportunities for outside investigators to collaborate using complete study data.

Сроки обмена IPD

No later than three years after the end of the final participant follow-up or two years after the main paper of the trial has been published, whichever comes first

Совместное использование IPD Поддерживающий тип информации

  • STUDY_PROTOCOL
  • САП

Информация о лекарствах и устройствах, исследовательские документы

Изучает лекарственный продукт, регулируемый FDA США.

Нет

Изучает продукт устройства, регулируемый Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов США.

Нет

Эта информация была получена непосредственно с веб-сайта clinicaltrials.gov без каких-либо изменений. Если у вас есть запросы на изменение, удаление или обновление сведений об исследовании, обращайтесь по адресу register@clinicaltrials.gov. Как только изменение будет реализовано на clinicaltrials.gov, оно будет автоматически обновлено и на нашем веб-сайте. .

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