<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT01681862</url>
  </required_header>
  <id_info>
    <org_study_id>1R21HS020982-01A1</org_study_id>
    <secondary_id>12-01040</secondary_id>
    <nct_id>NCT01681862</nct_id>
  </id_info>
  <brief_title>Insights for Community Health</brief_title>
  <official_title>Insights for Community Health</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>NYU Langone Health</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>New York City Department of Health and Mental Hygiene</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>NYU Langone Health</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      High blood pressure is the number one cause of death for Blacks in the United States. A major&#xD;
      reason for the high rates of cardiovascular deaths is poor blood pressure control. Improving&#xD;
      blood pressure control leads to large reductions in cardiovascular deaths in Blacks and can&#xD;
      be achieved through interventions targeting self-management behaviors. Yet, despite the&#xD;
      proven benefits of these interventions, there is little evidence of their role in&#xD;
      community-based settings. In NYC, the Department of Health and Mental Hygiene (DOHMH) has&#xD;
      developed Keep on Track, a volunteer-run, community program that aims to lower blood pressure&#xD;
      of older adults through blood pressure monitoring sessions, brief counseling and health&#xD;
      education. With support from DOHMH, lay health workers at faith-based organizations and&#xD;
      senior centers take blood pressure readings for community members, record their readings on&#xD;
      index cards and provide counseling to support lifestyle change and health care access.&#xD;
      However, lay health workers administrating the program report difficulties managing the&#xD;
      volume of tracking cards, and express interest in better tools to manage the information. To&#xD;
      address this limitation, the primary aim of this study is to test the feasibility of&#xD;
      implementing a Personal Health Record (PHR) system in two predominately Black churches in NYC&#xD;
      to help lay health workers track changes in blood pressure and health behaviors of the&#xD;
      participating congregants. The secondary aims are to evaluate the effect of the PHR system on&#xD;
      changes in blood pressure, physical activity, weight loss, fruit and vegetable intake, and&#xD;
      number of visits to a primary care physician from baseline to 9 months. The investigators&#xD;
      hypothesize that congregants who enroll in the PHR system will have a greater reduction in&#xD;
      BP; an increased intake of fruits and vegetables and levels of physical activity; weight&#xD;
      loss; and report a great number of visits to their doctor at 9 months.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Poor blood pressure (BP) control is major contributor to the racial disparity in HTN among&#xD;
      Blacks; the odds of poor BP control are 40% higher among Blacks as compared to Whites.&#xD;
      Improving BP control leads to significant cardiovascular risk reduction in Blacks and can be&#xD;
      achieved through evidence-based interventions targeting self-management behaviors that are&#xD;
      coordinated with primary care in a &quot;medical neighborhood&quot;. Despite the efficacy of these&#xD;
      interventions, they are not widely disseminated to community-based settings, or linked as&#xD;
      &quot;community resources&quot; to primary care clinics. The challenge for local health departments is&#xD;
      to redesign these evidence-based approaches to function at the level of resources and skills&#xD;
      available in typical community-based organizations (CBO). Health IT could build the capacity&#xD;
      of CBOs to implement evidence-based models, allowing for broader translation of life-saving&#xD;
      interventions, and lay a foundation for coordination of care for people with HTN. In New York&#xD;
      City, the Department of Health and Mental Hygiene (NYC DOHMH) has developed Keep on Track&#xD;
      (KOT) - a volunteer-run program designed to lower BP in older adults through biweekly BP&#xD;
      monitoring sessions and health education. With technical and material support from DOHMH, lay&#xD;
      health workers (LHW) at senior centers and faith-based organizations take BP readings for&#xD;
      community members, record their readings on index cards and provide brief counseling to&#xD;
      support lifestyle change and healthcare access. A limitation of the program is the use of&#xD;
      paper BP tracking cards, which LHWs find difficult to efficiently review for purposes of&#xD;
      targeted outreach and referral. They express interest in alternative tools for information&#xD;
      management, which would be more conducive to organized outreach to church members with high&#xD;
      BP, to support them in their efforts at lifestyle change and their attempts to gain access to&#xD;
      high quality healthcare.&#xD;
&#xD;
      In order to address this important limitation, the investigators will assess the feasibility&#xD;
      of implementing a Personal Health Record (PHR) system and Congregational Dashboard customized&#xD;
      to support KOT LHWs in two predominately Black churches in NYC to track both individual and&#xD;
      aggregate changes in BP and health behaviors among participating congregants. The&#xD;
      investigators propose that PHR implementation could improve the capacity of the Health&#xD;
      Ministry to manage information and heighten the impact of KOT. Specifically the investigators&#xD;
      propose that PHR implementation could improve community-based BP control programs by enabling&#xD;
      LHWs to adopt elements of the Chronic Care Model:1) targeted outreach to participating&#xD;
      congregants most in need of support for health behavior change; 2) collaborative goal-setting&#xD;
      at both the individual and church-level; and 3) empowering members to gain access to&#xD;
      healthcare and present physicians with BP tracking reports.&#xD;
&#xD;
      Primary Aim: To assess the feasibility of implementing a customized PHR system to support a&#xD;
      church-based BP monitoring program in two predominately Black churches in New York City.&#xD;
&#xD;
      Secondary Aims: To evaluate the effect of implementing the PHR system on:&#xD;
&#xD;
        1. Changes in systolic and diastolic BP from baseline to 9 months&#xD;
&#xD;
        2. Changes in daily servings of fruits and vegetables; level of physical activity;&#xD;
           within-participant weight loss; and number of visits to the primary care physician (PCP)&#xD;
           from baseline to 9 months&#xD;
&#xD;
      Hypothesis: Congregants who enroll in the PHR system will exhibit a reduction in BP; an&#xD;
      increased intake of fruits and vegetables and levels of physical activity; within-participant&#xD;
      weight loss; and report a great number of visits to their PCP at 9 months.&#xD;
&#xD;
      Outcomes for the primary and secondary aims will be assessed at the church- and&#xD;
      individual-levels. An ongoing formative evaluation will be conducted to identify barriers and&#xD;
      facilitators to PHR implementation, and garner suggestions for improvement. Data collected&#xD;
      from the formative evaluation will inform necessary system modifications and continuous&#xD;
      refinements. A process evaluation will also be conducted with the RE-AIM framework. BP will&#xD;
      be assessed with a validated automated BP monitor based on American Heart Association (AHA)&#xD;
      guidelines. Health behaviors will be assessed with well-validated self-report measures;&#xD;
      weight loss will be estimated as the difference in weight between baseline and 9 months.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date>September 2012</start_date>
  <completion_date type="Actual">July 2015</completion_date>
  <primary_completion_date type="Actual">July 2015</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Feasibility assessment</measure>
    <time_frame>2 years</time_frame>
    <description>RE-AIM framework and ongoing formative evaluation</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Blood pressure</measure>
    <time_frame>9 months</time_frame>
    <description>Blood pressure readings will be taken by trained LHWs using a well-validated automated BP monitor. One of the critical factors in this study is the measurement of BP in the church setting. We will select a validated blood pressure monitor that avoids observer bias, can take a series of readings while the patient is seated quietly, and has the capability of uploading the readings into the PHR. In keeping with KOT and AHA guidelines, patients will be seated quietly with an appropriately sized cuff on the non-dominant arm. The device will be programmed to take three readings at one minute intervals, after an initial rest period of five minutes. The average of three readings will be used as the BP measure for each visit.</description>
  </secondary_outcome>
  <other_outcome>
    <measure>Daily servings of fruits and vegetables</measure>
    <time_frame>9-months</time_frame>
    <description>Fruit and vegetable intake will be assessed using the 36-item measure developed by Resnicow et al. and validated in a large sample of Black adults participating in the Eat for Life church-based trial. The measure is based on the Health Habits and History Questionnaire and was tailored to foods commonly eaten within the Black population. Participants are asked to indicate number of times that they ate each item in the last seven days and the amount of food (1/2 cup, 1 cup). Portion size is fixed to a medium serving size. The measure will be administered at the baseline and 9-month follow-up visit.</description>
  </other_outcome>
  <other_outcome>
    <measure>Physical Activity</measure>
    <time_frame>9 months</time_frame>
    <description>Physical activity will be assessed with the 7-item International Physical Activity Questionnaire (IPAQ)-short version. The short-IPAQ assesses the amount of health-related vigorous and moderate-intensity physical activity as well as sedentary behaviors in adults over a one week period. The number of hours and minutes per day participants report spending in various types of physical activity is multiplied by the average metabolic equivalent (METs) of each category and summed to calculate energy expenditure as kcal/kg/minutes/week. The IPAQ's reliability and validity is well-established in diverse populations. The measure will be administered at the baseline and 9-month follow-up visit.</description>
  </other_outcome>
  <other_outcome>
    <measure>Weight loss</measure>
    <time_frame>9-months</time_frame>
    <description>Weight will be measured without shoes and with light clothes using a validated digital scale. Measurements will be recorded to the nearest 0.1 kg.</description>
  </other_outcome>
  <other_outcome>
    <measure>Number of visits to the primary care physician</measure>
    <time_frame>9-months</time_frame>
    <description>Number of visits to a PCP will be assessed with a validated single-item developed by the Stanford Research Center. The measure is designed to serve as a proxy for healthcare utilization in the past 6 months and will assist in determining whether the PHR program facilitated coordination of care across the community and clinic settings. Participant that report seeing their PCP will also be asked if they shared their PHR BP tracking reports with the physician. The measure will be administered at the baseline and 9-month follow-up visit.</description>
  </other_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Actual">55</enrollment>
  <condition>Hypertension</condition>
  <arm_group>
    <arm_group_label>Personal Health Record</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants data collected during the scheduled blood pressure sessions will be uploaded to the church PHR system. Lay health workers (LHWs) will then have the capability to access the blood pressure readings and health behavior data through the Congregational Dashboard where they can display the information in easy-to-read charts and graphs that highlight the blood pressure trends across the measurements and changes in fruit and vegetable intake, level of physical activity and weight. The registry will also incorporate computerized health education modules through and evidence-based guidelines for blood pressure control and the NHLBI publications &quot;Your Guide to Lowering Blood Pressure&quot; and &quot;Facts about the DASH Eating Plan.&quot;</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Personal Health Record</intervention_name>
    <description>Participants data collected during the scheduled blood pressure sessions will be uploaded to the church PHR system. Lay health workers (LHWs) will then have the capability to access the blood pressure readings and health behavior data through the Congregational Dashboard where they can display the information in easy-to-read charts and graphs that highlight the blood pressure trends across the measurements and changes in fruit and vegetable intake, level of physical activity and weight. The registry will also incorporate computerized health education modules through and evidence-based guidelines for blood pressure control and the NHLBI publications &quot;Your Guide to Lowering Blood Pressure&quot; and &quot;Facts about the DASH Eating Plan.&quot;</description>
    <arm_group_label>Personal Health Record</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  age ≥18 years old;&#xD;
&#xD;
          -  Are a member of the congregation at one of the participating churches;&#xD;
&#xD;
          -  Self-identify as African American/Black and&#xD;
&#xD;
          -  Have a diagnosis of HTN (either by self-report or taking at least one antihypertensive&#xD;
             medication).&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Inability to comply with the study protocol (either self-selected or by indicating&#xD;
             during the consent procedures that s/he cannot complete all requested tasks) or&#xD;
&#xD;
          -  Has a serious comorbid medical condition (e.g., psychiatric illness, cognitive&#xD;
             impairment due to stroke, dementia, Alzheimer's, etc.).&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Antoinette Schoenthaler, EdD</last_name>
    <role>Principal Investigator</role>
    <affiliation>NYU School of Medicine</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>NYC Department of Health and Mental Hygiene</name>
      <address>
        <city>New York</city>
        <state>New York</state>
        <zip>10013</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>NYU School of Medicine</name>
      <address>
        <city>New York</city>
        <state>New York</state>
        <zip>10016</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>October 2015</verification_date>
  <study_first_submitted>September 5, 2012</study_first_submitted>
  <study_first_submitted_qc>September 7, 2012</study_first_submitted_qc>
  <study_first_posted type="Estimate">September 10, 2012</study_first_posted>
  <last_update_submitted>October 5, 2015</last_update_submitted>
  <last_update_submitted_qc>October 5, 2015</last_update_submitted_qc>
  <last_update_posted type="Estimate">October 6, 2015</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>NYU Langone Health</investigator_affiliation>
    <investigator_full_name>Antoinette Schoenthaler</investigator_full_name>
    <investigator_title>Assistant Professor of Medicine</investigator_title>
  </responsible_party>
  <keyword>Hypertension</keyword>
  <keyword>African American</keyword>
  <keyword>Personal Health Record</keyword>
  <keyword>Faith-based Organizations</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Hypertension</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT01681862
org study id: 1R21HS020982-01A1
secondary id: 12-01040
nct id: NCT01681862
lead sponsor: 
collaborator: 
has dmc: Yes
High blood pressure is the number one cause of death for Blacks in the United States. A major
      reason for the high rates of cardiovascular deaths is poor blood pressure control. Improving
      blood pressure control leads to large reductions in cardiovascular deaths in Blacks and can
      be achieved through interventions targeting self-management behaviors. Yet, despite the
      proven benefits of these interventions, there is little evidence of their role in
      community-based settings. In NYC, the Department of Health and Mental Hygiene (DOHMH) has
      developed Keep on Track, a volunteer-run, community program that aims to lower blood pressure
      of older adults through blood pressure monitoring sessions, brief counseling and health
      education. With support from DOHMH, lay health workers at faith-based organizations and
      senior centers take blood pressure readings for community members, record their readings on
      index cards and provide counseling to support lifestyle change and health care access.
      However, lay health workers administrating the program report difficulties managing the
      volume of tracking cards, and express interest in better tools to manage the information. To
      address this limitation, the primary aim of this study is to test the feasibility of
      implementing a Personal Health Record (PHR) system in two predominately Black churches in NYC
      to help lay health workers track changes in blood pressure and health behaviors of the
      participating congregants. The secondary aims are to evaluate the effect of the PHR system on
      changes in blood pressure, physical activity, weight loss, fruit and vegetable intake, and
      number of visits to a primary care physician from baseline to 9 months. The investigators
      hypothesize that congregants who enroll in the PHR system will have a greater reduction in
      BP; an increased intake of fruits and vegetables and levels of physical activity; weight
      loss; and report a great number of visits to their doctor at 9 months.
Poor blood pressure (BP) control is major contributor to the racial disparity in HTN among
      Blacks; the odds of poor BP control are 40% higher among Blacks as compared to Whites.
      Improving BP control leads to significant cardiovascular risk reduction in Blacks and can be
      achieved through evidence-based interventions targeting self-management behaviors that are
      coordinated with primary care in a "medical neighborhood". Despite the efficacy of these
      interventions, they are not widely disseminated to community-based settings, or linked as
      "community resources" to primary care clinics. The challenge for local health departments is
      to redesign these evidence-based approaches to function at the level of resources and skills
      available in typical community-based organizations (CBO). Health IT could build the capacity
      of CBOs to implement evidence-based models, allowing for broader translation of life-saving
      interventions, and lay a foundation for coordination of care for people with HTN. In New York
      City, the Department of Health and Mental Hygiene (NYC DOHMH) has developed Keep on Track
      (KOT) - a volunteer-run program designed to lower BP in older adults through biweekly BP
      monitoring sessions and health education. With technical and material support from DOHMH, lay
      health workers (LHW) at senior centers and faith-based organizations take BP readings for
      community members, record their readings on index cards and provide brief counseling to
      support lifestyle change and healthcare access. A limitation of the program is the use of
      paper BP tracking cards, which LHWs find difficult to efficiently review for purposes of
      targeted outreach and referral. They express interest in alternative tools for information
      management, which would be more conducive to organized outreach to church members with high
      BP, to support them in their efforts at lifestyle change and their attempts to gain access to
      high quality healthcare.

      In order to address this important limitation, the investigators will assess the feasibility
      of implementing a Personal Health Record (PHR) system and Congregational Dashboard customized
      to support KOT LHWs in two predominately Black churches in NYC to track both individual and
      aggregate changes in BP and health behaviors among participating congregants. The
      investigators propose that PHR implementation could improve the capacity of the Health
      Ministry to manage information and heighten the impact of KOT. Specifically the investigators
      propose that PHR implementation could improve community-based BP control programs by enabling
      LHWs to adopt elements of the Chronic Care Model:1) targeted outreach to participating
      congregants most in need of support for health behavior change; 2) collaborative goal-setting
      at both the individual and church-level; and 3) empowering members to gain access to
      healthcare and present physicians with BP tracking reports.

      Primary Aim: To assess the feasibility of implementing a customized PHR system to support a
      church-based BP monitoring program in two predominately Black churches in New York City.

      Secondary Aims: To evaluate the effect of implementing the PHR system on:

        1. Changes in systolic and diastolic BP from baseline to 9 months

        2. Changes in daily servings of fruits and vegetables; level of physical activity;
           within-participant weight loss; and number of visits to the primary care physician (PCP)
           from baseline to 9 months

      Hypothesis: Congregants who enroll in the PHR system will exhibit a reduction in BP; an
      increased intake of fruits and vegetables and levels of physical activity; within-participant
      weight loss; and report a great number of visits to their PCP at 9 months.

      Outcomes for the primary and secondary aims will be assessed at the church- and
      individual-levels. An ongoing formative evaluation will be conducted to identify barriers and
      facilitators to PHR implementation, and garner suggestions for improvement. Data collected
      from the formative evaluation will inform necessary system modifications and continuous
      refinements. A process evaluation will also be conducted with the RE-AIM framework. BP will
      be assessed with a validated automated BP monitor based on American Heart Association (AHA)
      guidelines. Health behaviors will be assessed with well-validated self-report measures;
      weight loss will be estimated as the difference in weight between baseline and 9 months.
allocation: N/A
intervention model: Single Group Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Feasibility assessment
time frame: 2 years
description: RE-AIM framework and ongoing formative evaluation
measure: Blood pressure
time frame: 9 months
description: Blood pressure readings will be taken by trained LHWs using a well-validated automated BP monitor. One of the critical factors in this study is the measurement of BP in the church setting. We will select a validated blood pressure monitor that avoids observer bias, can take a series of readings while the patient is seated quietly, and has the capability of uploading the readings into the PHR. In keeping with KOT and AHA guidelines, patients will be seated quietly with an appropriately sized cuff on the non-dominant arm. The device will be programmed to take three readings at one minute intervals, after an initial rest period of five minutes. The average of three readings will be used as the BP measure for each visit.
measure: Daily servings of fruits and vegetables
time frame: 9-months
description: Fruit and vegetable intake will be assessed using the 36-item measure developed by Resnicow et al. and validated in a large sample of Black adults participating in the Eat for Life church-based trial. The measure is based on the Health Habits and History Questionnaire and was tailored to foods commonly eaten within the Black population. Participants are asked to indicate number of times that they ate each item in the last seven days and the amount of food (1/2 cup, 1 cup). Portion size is fixed to a medium serving size. The measure will be administered at the baseline and 9-month follow-up visit.
measure: Physical Activity
time frame: 9 months
description: Physical activity will be assessed with the 7-item International Physical Activity Questionnaire (IPAQ)-short version. The short-IPAQ assesses the amount of health-related vigorous and moderate-intensity physical activity as well as sedentary behaviors in adults over a one week period. The number of hours and minutes per day participants report spending in various types of physical activity is multiplied by the average metabolic equivalent (METs) of each category and summed to calculate energy expenditure as kcal/kg/minutes/week. The IPAQ's reliability and validity is well-established in diverse populations. The measure will be administered at the baseline and 9-month follow-up visit.
measure: Weight loss
time frame: 9-months
description: Weight will be measured without shoes and with light clothes using a validated digital scale. Measurements will be recorded to the nearest 0.1 kg.
measure: Number of visits to the primary care physician
time frame: 9-months
description: Number of visits to a PCP will be assessed with a validated single-item developed by the Stanford Research Center. The measure is designed to serve as a proxy for healthcare utilization in the past 6 months and will assist in determining whether the PHR program facilitated coordination of care across the community and clinic settings. Participant that report seeing their PCP will also be asked if they shared their PHR BP tracking reports with the physician. The measure will be administered at the baseline and 9-month follow-up visit.
arm group label: Personal Health Record
arm group type: Experimental
description: Participants data collected during the scheduled blood pressure sessions will be uploaded to the church PHR system. Lay health workers (LHWs) will then have the capability to access the blood pressure readings and health behavior data through the Congregational Dashboard where they can display the information in easy-to-read charts and graphs that highlight the blood pressure trends across the measurements and changes in fruit and vegetable intake, level of physical activity and weight. The registry will also incorporate computerized health education modules through and evidence-based guidelines for blood pressure control and the NHLBI publications "Your Guide to Lowering Blood Pressure" and "Facts about the DASH Eating Plan."
intervention type: Behavioral
intervention name: Personal Health Record
description: Participants data collected during the scheduled blood pressure sessions will be uploaded to the church PHR system. Lay health workers (LHWs) will then have the capability to access the blood pressure readings and health behavior data through the Congregational Dashboard where they can display the information in easy-to-read charts and graphs that highlight the blood pressure trends across the measurements and changes in fruit and vegetable intake, level of physical activity and weight. The registry will also incorporate computerized health education modules through and evidence-based guidelines for blood pressure control and the NHLBI publications "Your Guide to Lowering Blood Pressure" and "Facts about the DASH Eating Plan."
arm group label: Personal Health Record
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Antoinette Schoenthaler, EdD
role: Principal Investigator
affiliation: NYU School of Medicine
facility: 
facility: 
country: United States
responsible party type: Principal Investigator
investigator affiliation: NYU Langone Health
investigator full name: Antoinette Schoenthaler
investigator title: Assistant Professor of Medicine
mesh term: Hypertension