Among black patients with hypertension, a community-based lifestyle intervention taking place in churches conferred a greater reduction in systolic BP than a control intervention, according to the results of the FAITH study.
“African-Americans have a significantly greater burden of hypertension and heart disease, and our findings prove that people with uncontrolled hypertension can, indeed, better manage their blood pressure through programs administered in places of worship,” Gbenga Ogedegbe, MD, MPH, FACP, Dr. Adolph & Margaret Berger Professor of Population Health and Medicine, chief of the Division of Health & Behavior and director of the Center for Healthful Behavior Change at NYU School of Medicine and associate vice chancellor for global network academic planning at the NYU Office of Global Programs, said in a press release. “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.”
For the FAITH study, the researchers analyzed 373 black participants with hypertension (mean age, 64 years; 76% women) from 32 churches in New York. The churches were divided into eight cohorts of four churches each, and each church was randomly assigned for its patients to receive a therapeutic lifestyle change intervention plus motivational interviewing sessions or health education alone. Within each cohort of four churches, two were assigned the therapeutic lifestyle change intervention and two were assigned health education.
“The premise for this study is twofold,” Ogedegbe told Cardiology Today. “First, African Americans have a disproportionately higher rate of high blood pressure and its associated complications like stroke and chronic kidney disease. Second, they have poorer access to care and as such may not benefit from practice-based lifestyle interventions that have been shown to help reduce high blood pressure.”
Therapeutic lifestyle change
The therapeutic lifestyle change intervention consisted of 11 90-minute weekly group sessions focused on adoption of healthy lifestyle behaviors, meal planning strategies, stress management advice, medication adherence, structured goal setting and tastings of healthy foods. Participants in this intervention were asked to keep a food and activity diary. Elements of prayer, scripture and faith-based discussion points related to health were included. After those sessions, there were three monthly individual motivational interviewing sessions to help participants focus on problem-solving and maintaining lifestyle changes. The health education control group received one session on hypertension management focusing on lifestyle behaviors and medication management, during which patients were given an NIH booklet on BP, plus 10 informational sessions on various health topics.
All patients had uncontrolled hypertension, defined as BP of at least 140/90 mm Hg or, in those with diabetes or chronic kidney disease, BP at least 130/80 mm Hg. The mean BP at baseline was 153/87 mm Hg.
The primary outcome was change in BP at 6 months. The secondary outcome was BP control at 9 months.
Compared with the control group, the therapeutic lifestyle change group had a greater systolic BP reduction at 6 months (5.79 mm Hg; P = .029), according to the researchers.
At 9 months, the treatment effect was still present but less significant (5.21 mm Hg; P = .068), Ogedegbe and colleagues wrote.
“The most important takeaways are that healthy lifestyle behavior programs can be implemented safely in faith-based settings, and that these programs can be implemented by lay community and church members and really does not require a health professional,” Ogedegbe told Cardiology Today.
Between-group differences in reduction in diastolic BP (0.41 mm Hg) and mean arterial pressure (2.24 mm Hg) were not significant at 6 months, the researchers wrote.
BP control at 9 months was numerically but not significantly higher in the therapeutic lifestyle change group (57% vs. 48.8%; OR = 1.43; 95% CI, 0.9-2.28), according to the researchers.
“There are numerous blood pressure screening programs already. What would be needed now is to incorporate into those programs group sessions on lifestyle behavior counseling,” Ogedegbe told Cardiology Today. “Findings from this study have now provided policymakers the information to disseminate and create policy for funding similar programs in faith-based settings.”
In a related editorial, Jeremy B. Sussman, MD, MS, and Michele Heisler, MD, MPA, both from the department of internal medicine and the Institute for Healthcare Policy and Innovation at the University of Michigan and the Center for Clinical Management Research at Veterans Affairs Ann Arbor Healthcare System, wrote that the treatment effect from this intervention was more modest than one conducted at black barbershops.
“These two trials had several differences that may explain the difference in outcomes,” they wrote. “First, the studies used different interventions. Behavioral change alone, like that encouraged by the FAITH Study, has many benefits, but it is a more difficult way to lower blood pressure than medication management. Second, the barbershop trial achieved significantly higher levels of participant engagement in the intervention. Participants in the barbershop program received on average seven in-person pharmacist visits and four follow-up telephone calls. In contrast, in the FAITH trial, only 46% of intervention participants completed all three of the individual telephone counseling sessions. Third, although both trials enrolled predominantly low-income black adults, there were important differences in their participants. The barbershop study exclusively enrolled men who had at least one haircut every 6 weeks for at least 6 months. The FAITH study participants were primarily women, but they may or may not have attended the church regularly. These differences in eligibility criteria may also explain why the barbershop trial achieved a remarkably low attrition rate (< 10% in each arm) at 6 months, whereas the FAITH trial only had complete data on 71% of participants at 6 months, a rate similar to other trials of low-income urban populations.” – by Erik Swain