The primary purpose of this project is to establish the efficacy of a novel peer support
intervention to reduce hypertension among members of veteran service organizations (VSOs).
Specifically, we plan to demonstrate that veterans participating in a peer support
intervention, as opposed to a purely didactic educational program, will have better blood
pressure control, increased engagement in blood pressure lowering activities (such as
exercise), and a more active stance as patients.
IMPACT ON VETERANS HEALTH It is anticipated that this intervention will help participating
veterans achieve optimal hypertension control. Doing so will reduce their risks for heart
disease and stroke, and improve their quality of life. It is hoped that the collaborative
nature of this intervention will strengthen the VA's ties to the veteran community, and
establish important "partnerships for health." If successful, this intervention could serve
as a model for managing chronic disease both within and outside the VA system.
BACKGROUND/RATIONALE Despite consensus that effective hypertension treatment reduces
morbidity and mortality, many patients in the United States continue to have suboptimal
blood pressure (BP) control. Even with the provider resources and motivated patients
inherent in a randomized clinical trial, over a third of patients participating in the
ALLHAT study were not at their goal blood pressure of 140/90 after five years. Similarly,
within VISN 12 we have found that as many as 30% of patients with hypertension are above the
target BP of 140/90, despite routine physician reminders to patients who are above these
goals. Moreover, preliminary results of an internally funded randomized trial suggest
minimal impact of further physician-focused interventions to reduce patients' blood
OBJECTIVES We will have two primary objectives. First, because the intervention proposed is
novel, we believe we need to demonstrate its efficacy in a methodologically rigorous
fashion. Specifically we plan to demonstrate that veterans participating in a peer support
intervention will have improved blood pressure control, knowledge of blood pressure
treatment, both generally and for themselves, and a more active stance as patients.
Second, we will carefully examine the process by which our intervention achieves these
goals, including examining such key structural variables as the frequency of peer support
meetings, attendance of participants at these meetings, and use of healthcare professional
support by the group leaders. As part of this second objective, we also seek to understand
the fidelity with which the peer leaders are to deliver the intervention, and the
satisfaction of both support group participants and leaders with the intervention.
METHODS There are three primary activities in the present project.
First, academicians from the Zablocki VA are working with the VFW and other community groups
to develop a community-academic partnership that follows the principles of community-based
participatory research. This key activity is underway and will continue beyond the present
period of funding. Second, the centerpiece of the present grant is a cluster randomized
clinical trial (RCT) of the use of peer-led support groups to improve BP control in patients
with hypertension. Fifty posts drawn from the Veterans of Foreign Wars, American Legion,
Vietnam Veterans Association, and National Association of Black Veterans will be randomly
assigned to receive professionally delivered education regarding hypertension or to a peer
support intervention. The third activity is an evaluation of the processes involved in
delivering the peer support intervention that will allow for successful replication, or to
provide insight into why the expected improvement in BP control did not occur.
1. Member of a post or auxiliary of a participating veterans' service organization or
Elks Lodge in the 70 miles surrounding the Milwaukee VAMC.
2. Hypertension as established by one of: a) Average SBP greater than 140 or DBP
greater than 90 at two baseline visits b) SBP greater than 130 or DBP greater than
90 at two baseline visits, plus patient report of diabetes mellitus and use of a
hypoglycemic agent at the baseline visit c) Self-reported hypertension plus
self-reported current treatment with at least one antihypertensive drug at baseline
3. Willingness to sign informed consent document.
1. Medical or social condition preventing routine attendance at a monthly meeting.
2. Inability to communicate with other post members because of language barrier or
physical limitation (e.g., prior stroke).