Interactive Multirisk-Factor Intervention for Hypertension (HTN) Blacks

• 1-proportion of study subjects who achieve adequate adherence (greater than or equal to 80% of doses taken) at the end of the intervention period [ Time Frame: 8 months ] [ Designated as safety issue: No ]
  Outcomes were assessed at baseline, 4 months, 8 months (the end of the study intervention) and 12 months.
• 2-consumption of more than 5 servings of fruits and vegetables a day, less than 30% of calories from fat, and less than 2400 mg of sodium a day at the end of the intervention period [ Time Frame: 8 months ] [ Designated as safety issue: No ]
  Outcomes were assessed at baseline, 4 months, 8 months (the end of the study intervention) and 12 months.
• 3-adherence to CDC-ACSM recommendations for moderate intensity physical activity at the end of the intervention period [ Time Frame: 8 months ] [ Designated as safety issue: No ]
  Outcomes were assessed at baseline, 4 months, 8 months (the end of the study intervention) and 12 months.

• 1-proportion of study subjects who achieve adequate adherence (greater than or equal to 80% of doses taken) at the end of the intervention period
• 2-consumption of more than 5 servings of fruits and vegetables a day, less than 30% of calories from fat, and less than 2400 mg of sodium a day at the end of the intervention period
• 3-adherence to CDC-ACSM recommendations for moderate intensity physical activity at the end of the intervention period
• 4- patients receiving TLC-HTN-AA will be more likely to become adherent to all 3 target regimens (above) than patients in the control group

• 1-TLC-HTN-AA use will reduce the mean blood pressure and the proportion of the treatment group having uncontrolled hypertension at the end of the intervention period
• 2-The effects of TLC-HTN-AA on adherence of patients to their regiments and on blood pressure will be sustained during a 4-month maintenance period during which patients will not be exposed to the intervention
• 3-TLC-HTN-AA's effects on blood pressure will be mediated, in part, through improved adherence of patients to their treatment regimens
• 4-TLC-HTN-AA will be perceived by patients and professionals as an acceptable, useable, and useful health care service
• 5-Improvements in behavioral variables such as intention and self-efficacy, among, others, will mediate improvement in regimen adherence

The aim of this study is to assess the efficacy of Telephone-Linked_Care for Hypertension Regimen Adherence in an African American population (TLC-HTN-AA). TLC-HTN-AA is a computer-based telecommunication system that will monitor, educate and counsel African American adults with hypertension on adherence to medication, diet, and exercise. The primary hypotheses are:

1. TLC-HTN-AA use will improve medication regiment adherence
2. TLC-HTN-AA will improve adherence to 3 healthy diet recommendations
3. TLC-HTN-AA will improve levels of regular exercise
4. Patients receiving TLC-HTN-AA will be more likely to become adherent to all 3 target regiments than patients in the control group

• Active Comparator: Automated Telephone Program
  The intervention was a totally automated, computer-based, interactive telephone counseling system called Telephone- Linked-Care, designed to monitor, educate, and counsel African-American adults with hypertension and to provide summary data regularly to the patient's primary care provider.
  Intervention: Behavioral: Automated Telephone Program
• Placebo Comparator: Health Behavior Education
  The comparator group received health education relating to the management of hypertension. Members of this group also received standard primary medical care.

Inclusion Criteria:

• a patient with a primary care provider at one of Boston Medical Center's Adult Primary Care Medical Practices or one of three HealthNet health centers participating in the study
• have a physician diagnosis of hypertension
• be African American by self-report
• be 35 years of age or older
• be prescribed at least one medication for hypertension
• have poorly controlled blood pressure
• be non-adherent to at least one hypertensive medication
• understand spoken English
• have a home telephone

Exclusion Criteria:

• patients for whom a medication, diet or exercise regiment adherence improvement or maintenance program would be inappropriate
• patients with a terminal illness
• patients with severe medical or psychiatric illness
• patients with cognitive difficulty